NTCG The Lighthouse                                          Return to Church Questionnaire
Address: Melbourne Rd, Leicester LE2 0DR - www.ntcgthelighthouse.org

All data will be collected and stored in a private & confidential manner.

NOTICE: If you are registering other family or friends members, can you complete the form for each person.

There will be an eventbrite booking system in place on the website for you to register to attend church service (you will need to do this weekly). Alternatively – you can contact the church information line on Information line number 07957 422 827
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1.First Name: *
2. Last Name: *
3. Email: *
4. Contact Number: *
5. What is your address? *
6. Postcode? *
7. Are you planning to return to church when we go back for worship? *
8. Do you have any underlying health issues or other health concerns? *
9. If, yes, to health concerns, please describe?
10. Have you been in close contact with anyone who has been diagnosed with Covid-19 infection in the last 14 days? *
11. Have you been in close contact with anyone exhibiting symptoms of Covid-19 infection? *
12. Have you had a positive test for Covid-19 in the last 14 days or have you been advised to self-isolate? *
13. Can you nominate a next of kin contact, please provide 1.Fullname, 2.Telephone/Mobile, 3.Email Address, in case of an emergency? *
14. I consent to provide sensitive information to NTCG The Lighthouse & I agree to the privacy notice on  https://ntcgthelighthouse.org/privacy-policy/ *
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