BEREA TEMPLE SDA CHURCH                                   RE-OPENING PRE-REGISTRATION FORM.                                           ENTER AT YOUR OWN RISK!                                                                                   The World Health Organization has declared, COVID-19, a Worldwide Pandemic. COVID-19 is a highly contagious disease for which there is currently no cure. BY ENTERING THESE FACILITIES AND PARTICIPATING IN SERVICES, YOU AGREE YOU ARE ENTERING AT YOUR OWN RISK, AND AGREE WE ARE NOT RESPONSIBLE IF YOU BECOME INFECTED. You will be required to answer screening questions on arrival at church, and have your temperature screened to attend Service. If your Temperature is greater than 100.4 Fahrenheit or 38 Celsius, you will be asked to return for worship on another Sabbath. Please maintain wearing your face mask at all times, and keeping at least 6ft distance during service. Use available hand sanitizer or wash hands for at least 20 seconds. Follow the Directions of Screeners, Ushers, Deacons, and Deaconess for you and others safety always. Please complete ALL requested information on form. It is essential that we collect this information in compliance with Department of Health Requirements for Contact Tracing. EVERYONE in attendance will need to complete a form.
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Date Of Service *
Name *
Telephone Number *
DO YOU HAVE "ANY" of the following symptoms: Fever or chills, cough, shortness of breath, difficulty breathing, fatigue, muscle or body aches, headache, loss of taste or smell, sore throat, congestion or runny nose, nausea, vomiting, or diarrhea. *
Within the past 14 days, have you been in close physical contact 6 feet or closer for at least 15 minutes with a person who is known to have laboratory confirmed COVID-19 or with anyone who has any symptoms consistent with COVID-19? Select Yes or No *
Are you isolating or quarantining because you may have been exposed to a person with COVID-19 or are you worried that you may be sick with COVID-19? *
Are you currently waiting on the results of a COVID-19 test other than routine/required tracking or asymptomatic testing by choice? *
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