Church Visit Registration
Service Time: 12:45 pm
Church Address: 12728 Manor Road, Glen Arm MD 21057
Contact us at life@mtzionlife.org

Sign in to Google to save your progress. Learn more
Name *
Email *
Phone number *
Are you fully vaccinated? *
Who will be attending church services? *
If you are bringing a guest(s) please provide their names. (Each person must comply with our Covid-19 requirements of wearing a mask and remaining 6ft apart) *
Have you experienced any of the following symptoms in the past 48 hours: fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, and/or diarrhea? *
Required
Within the past 14 days, have you been in close physical contact (6 feet or closer for a cumulative total of 15 minutes) with anyone who has received Positive Results from a COVID-19 test OR anyone who has displayed symptoms consistent with COVID-19? *
I understand that masks are required to be worn in the church at all times. *
Required
Waiver And Release of Liability:                                             COVID-19 is a highly contagious virus that spreads from person to person. By attending Mt. Zion AME Church, you agree to and abide by the procedures established by the church to protect all attendees and staff. You understand that you are voluntarily assuming the risks that you and your family may be exposed to or affected by COVID-19 while in/around the church or during the worship experience. By selecting “I agree” you are indicating that you have read and understood the terms and assume all the risks of attendance and participation in church services, and hereby absolve any liability against the church or any other parties *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Mount Zion AME Church. Report Abuse
Google Forms