SJUMC Wellness Month Contact Tracing/Registration form

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We appreciate your participation at SJUMC. Please fill out this form so we can have it for contact tracing.

The receptionist will/may check your temperature when you arrive, and will ask you a few questions related to
COVID-19 symptoms.

- Please wear a mask at all times
- If you or a member of your household has symptoms of any illness (cough, fever at any level, difficulty breathing), seek medical assistance and please STAY HOME.

If you have any questions, please contact the church at 916-421-1017 (office@sacjumc.com)

Email *

Which one are you attending? *

Jan. 12th at 11am, CrossFit, Jan 12th at 11am

Vital Check Up, Jan 16th after service

Music and Exercise, Jan. 19th at 10:30

Dental 101, Jan. 20 at 7pm Zoom

Dental 101, Jan 29, sat 10am Zoom

Long Term Care and Final Expense workshop, Jan 23rd after service

Long Term Care and Final Expense Workshop, Jan. 26, Wed, Zoom

Mental illness Support Group

Others

Other:

Full Name *

Cell Phone number *

How many in your household (including you) are coming with you? *

Other:

Type name(s) from your household (if you are the only one from your household, skip this question)

Do you agree with the Word About Risk and Responsibility (see the wording below) *

Yes

I will fill out the from at the church

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

Submit

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