Registration for Funeral

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This form is for funeral ceremonies at Saint Mina's Coptic Orthodox Church in Hamilton, Ontario, Canada.
Please use a valid email and a valid cell phone number (can receive/send SMS).

To keep everyone safe, please note that everyone will need to keep social distancing during the entire event. No physical touching, handshaking or hugging will be allowed. Each family will get to greet the families of the departed from a safe distance.

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Διεύθυνση ηλεκτρονικού ταχυδρομείου *

Name *

First and last name

Cell Phone *

Please make sure to use a cell phone number that can receive and send SMS

Home Address *

Please include your full home address (including city and postal code)

Funeral Date/Time *

Family Size *

How many family members will be joining you? Please include the total number (including yourself). If you family has more than 6 members, please fill this form for the first 6 members and then fill another form for the remaining members.

Family Members *

Please provide the names (first and last) of each family member that will be accompanying you (including yourself). Please use a comma after each name.

Declaration/Consent *

By filling this form, I confirm that my family and I ...

Yes

will be in the church on time and will follow all the organizational and safety procedures.

are members of the same family and live in the same household.

are completely free from any symptoms of sickness (fever, cough, and difficulty of breathing) for the last 14 days.

were not in contact with any COVID-19 infected individual in the last 14 days.

did not recently return from travel or have been in contact with someone who recently returned from travel for the last 14 days.

have not been diagnosed with COVID-19 or waiting for test results for the last 14 days.

are not actively involved in the treatment of COVID-19 patients.

will be wearing masks until the moment we receive communion and will not remove it at any other time.