Church Visit Details
Church Service Registration
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Email *
Your Name *
What service(s) will you be attending:
Church Service Date You Will Attend *
MM
/
DD
/
YYYY
Family/Child Name
Family/Child Name
Family/Child Name
Family/Child Name
Family/Child Name
Family/Child Name
Family/Child Name
Please answer that you understand the following statement.  By replying "Yes" I am saying that I understand and accept all risk associated with attending church service in-person.  I also acknowledge that I have: (1) not traveled within the last 14 days to an area significantly impacted by COVID-19 (2) I am not an at-risk individual, and (3) I do not currently have COVID-19 or COVID-19 like symptoms (fever, cough, etc.).  By entering the FMSDA building, I accept all personal liability of potential injuries or disease.  If you agree to these above terms, please type in "yes" as your answer below. *
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