Faith UCC Worship Registration/COVID Screening

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Please fill out a separate COVID screening form for EACH family member wishing to attend.

Our maximum capacity for church at this time is 75 people which includes the Pastor, organist, musicians, lay readers, ushers, and stream team. When we reach the maximum, registration will be closed.

Email *

Date of requested service *

YYYY

LAST Name (Please register each family member separately) *

FIRST Name (Please register each family member separately) *

Contact Number

Do you have a household member or close contact who has been diagnosed with COVID 19 in the past 2 weeks? *

Yes (If you answer yes, please stop now and plan to use an alternative option for watching or listening the service.)

Are you experiencing any symptoms consistent with COVID 19? (Not seasonal allergies -If you check anything other than No Symptoms please stop now and plan to use an alternative option for watching or listening to the service.) *

No Symptoms

Shortness of breath or trouble breathing?

Sore Throat

Shortness of Breath

Cough

Chills

Fever

New Taste of Loss or Smell

Muscle Pain and Body Ache

Diarrhea or vomiting

A copy of your responses will be emailed to the address you provided.

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