MASS SIGN UP

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MASS SIGN UP

Please answer the following questions honestly and in the best interests of everyone attending Mass:

First Name: *

Surname: *

Contact Phone Number (enter numbers only) *

Email Address: *

QUESTION 1: Would you like to attend Mass? *

Yes, I would like to attend Mass on my own

Yes, I would like to attend Mass with my family

Required

QUESTION 2: If your family will be attending Mass with you, how many family members in total (including you)?

QUESTION 3: Select Mass(es) you wish to attend: (check all boxes that apply) *

Sunday Mass @ 9:00 am

Wednesday Mass @ 8:00 am

Saturday Mass @ 5:30 pm

Required

QUESTION 4: Do you have sudden onset of any of the following COVID-19 symptoms? (Check all that apply) * *

Fever (>38° C) or a history of fever chills

Dry Cough (sudden onset)

Difficulty in breathing

Loss of smell and/or loss of taste

Body aches

Nausea, vomiting, diarrhoea

Fatigue/weakness

None of the above apply to me

Required

QUESTION 5: Under government and archdiocese guidelines, people who are (1) 60 years or over, OR (2) with comorbidities, OR (3) who are immuno-compromised, OR (4) vulnerable, are strongly advised not to attend Mass. (Check all that apply) *

60 years or older

Cardio Vascular disease or issues

Diabetes

Hypertension (high blood pressure)

Chronic kidney disease

Chronic pulmonary disease

Obesity

Do you live with someone who has any of the above

Are you immuno-compromised

Vulnerable (eg. pregnant)

None of the above apply to me

I prefer not to answer

Required

QUESTION 6: IN THE LAST 14 DAYS, in your community, were you in close contact or living with someone with any of the following: (Close contact means you were face-to-face (less than 1 metre) with the person or you were in a closed space (car, taxi or house) with the person for at least 15 minutes.) *

A person with flu like symptoms

A confirmed COVID-19 person or a person under investigation for COVID-19

None of the above

Required

QUESTION 7: IN THE LAST 14 DAYS have you? *

Worked in, or attended a healthcare facility where COVID-19 patients are treated?

Been admitted with severe pneumonia?

None of the above

Required

Do you have any comments or Questions?

Submit

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