Post COVID-19 LGM Entry Declaration Form

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PLEASE READ: This is a one off registration/declaration and you will be given a number which you need to give to member of staff anytime you come to pray, before entry to the mosque, we will admit our congregation on first come first in basis bearing in mind the limited number of people we can accommodate at the mosque in line with the new procedures of social distancing.
Please complete the form below. Every question must be carefully answered. Unfortunately, no one will be allowed to enter without completion of this form.

First name *

Last name *

Contact number *

email address *

Do you use a chair for prayer? *

Yes

I am a high risk person or I have anyone at home who is high risk *

Yes

PLEASE READ: I confirm that I make sure that I don't have any of the following symptoms in the last 24 hours prior to any time I attend a prayer the mosque (Please tick all boxes in order to be granted entry to the mosque): *

Cold or flu like symptoms "aching muscles, headache, blocked or runny nose, sore throat, sneezing

Fever

New cough or breathlessness

New fatigue or tiredness

Loss in the sense of smell or taste

Required

PLEASE READ: I confirm that I make sure that I fulfill all the requirements below any time I attend a prayer at the mosque (Please tick all boxes in order to be granted entry to the mosque): *

I come in a state of Wudu

I bring my own prayer mat

I wear face mask / face covering at all time I am in mosque

I bring a plastic bag for my shoes to put next to me when I am praying

I don't bring any child under 12, or those who cannot maintain social distancing or wear a face mask

I follow fully the guidance and instruction of staff and volunteers from entry to the mosque

I sanitize my hands and keep social distancing of more than 1 meter at all time I am in the mosque vicinity

I am not shielding at home or living with someone who is shielding or who is over 60

I am willing to pray the sunnah / optional prayers at home

Required

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