Covid-19 Entry into Worship Form

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We’re so glad you’re worshipping with us this morning. We are committed as a community to protecting each other and our neighbors from the Covid-19 pandemic by putting in place the following procedures. Please read through them carefully and sign this card to indicate your willingness to adhere to them before you are admitted to the service. For contact-tracing purposes, we ask that you provide contact information. We will not add you to any newsletter list or use this information for any purpose other than contact tracing. By filling out this form, you agree to contact us if you become ill or have contact with any known carrier of the Covid-19 virus. We will not use your name when letting people know that they’ve come into contact with someone carrying the virus. We ask that all present observe our guidelines and rules for health and safety during worship. We cannot and do not guarantee the absence of risk from your presence with us.

Email *

I attest that *

I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, swollen or purple toes, or new loss of taste or smell.

To the best of my knowledge I have not been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.

I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by state or local public health authorities.

I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.

Required

I agree to *

Allow my temperature to be taken before entering the worship space.

Wear a mask while I am in the worship space.

Maintain social distancing of six feet while in the worship space.

Follow any procedures posted on signs or electronic kiosks while in the worship space.

Follow verbal instructions from the worship leaders & ushers during the course of the service.

Required

Contact Tracing

Please fill out the following information so that we will be able to contact you if someone you attended worship with tests positive for Covid-19.

Name *

Phone *

Street Address *

City *

State *

Zip Code *

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