CCSW Attendance Register

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This form captures the details that government regulations require that we keep for contact tracing purposes after each interaction.

Please fill in your name; and the names of those with you *

Please state the purpose of your visit *

Indemnity *

I understand and acknowledge that participation in any activity at Christ Church Somerset West is completely voluntary and that participation in any public gathering may expose me and/or the members of my household to several risks, in particular, an elevated risk of exposure to COVID-19. By checking this box, I and the members of my household agree to indemnify and hold Christ Church Somerset West, its officers, employees, volunteers or other agents harmless from all claims and liability arising from any loss, illness, injury, or death to me and/or the members of my household occurring during or as a result of participation at any church activity. I and the members of my household further agree to follow all necessary rules and protocols put in place by Christ Church Somerset West, its officers, employees, volunteers or other agents.

Yes, I understand and acknowledge the above

Required

Describe any symptoms, if any. By leaving this blank, you declare that neither you nor any of those with you present with observable COVID-19 symptoms, namely fever, cough, sore throat, redness of eyes, or shortness of breath/difficulty in breathing, nor do you or any of those with you present with additional symptoms, including body aches, loss of smell/taste, nausea, vomiting, diarrhoea, fatigue, weakness or tiredness.

I or someone with me is presenting with symptoms

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