COLEGIO SAN AGUSTIN CHAPEL
CONTACT TRACING FORM
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Date attending mass *
MM
/
DD
/
YYYY
Name *
Address *
Contact number *
Gender *
Status *
Mass schedule attended *
Have you had any COVID 19 symptoms? (fever over 38 degrees celsius, dry cough, shortness of breath etc) *
Have you been exposed to anyone with COVID 19 symptoms in the last 4 weeks? *
Are you fully vaccinated? (NOTE: In accordance to the IATF Guidelines on religious gatherings, only fully vaccinated individuals are allowed for indoor gatherings. Please bring your vaccination card. ) *
Body temperature *
I acknowledge that CSA Chapel volunteers have discussed the quarantine protocol with me and that I insist on attending the Mass.  I understand that this release discharges CSA Chapel from any liability or claim that I, my heirs, or any personal representative may have against CSA Chapel with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to my attendance in mass. This liability waiver and release extend to the CSA Chapel in-charge and volunteers. (Kindly input your full name if you agree) *
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