COVID-19 REGISTRATION FORM WEDNESDAY 24th Feb 6PM SERVICE

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If you have any COVID -19 symptoms, we encourage you to please opt to stay home until you feel better or have been cleared

PLEASE READ CAREFULLY BEFORE COMPLETING.

This form needs to be completed in order for you to gain access to the Church Premises.
This form serves as an official declaration. All answers must be answered truthfully.

If you will be attending with your kids, please complete a form for each child (choose the option to 'SUBMIT ANOTHER RESPONSE' at the end when this one is complete and NOT 'EDIT YOUR RESPONSE' as this will delete the data for your first entry). An individual response is needed for all members of the family.

By completing this form you are reserving a seat for the service, once we have reached capacity (100 registered people) or the closing time for completing the form has been reached, no one will be able to register and this form will be closed.

NOTE:
1. You will be required to present yourself at the registration desk on arrival.
2. You must ensure that you bring your face mask which you will be required to wear for the duration of the
Sunday service, and while on Gracepoint premises.
3. We will do your temperature check on arrival.
4. You will be required to sanitize your hands on arrival

Email *

Name *

Surname *

ID Number/ (Date of birth if child)/ Passport number *

Contact Number *

Have you been in contact with someone confirmed to have contracted Covid-19 within the last 7 Days? *

YES

Have you had any of the following symptoms in the last 7 days or currently? *

Fever

Cough

Pains

Headache

Loss of sense of smell or appetite

None of the Above

Required

Do you have a mask which you will wear in this facility at all times? *

Yes

I hereby declare to the best of my knowledge that the information disclosed is correct at the time of completion. *

YES

!!!!The section below is for Gracepoint office use only. PLEASE IGNORE!!!!!

PLEASE DO NOT COMPLETE: Body Temperature Reading (Reading taken on the day) To be completed on your arrival, by a Gracepoint official

A copy of your responses will be emailed to the address you provided.

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