HOHCAI Weekly Service Registration Form
Pre-registration is strongly encouraged as seating is limited, however, onsite registration is available as well. You must register for every Sunday & Wednesday gathering that you plan to attend until further notice.
Service Date
*
-
Month
-
Day
Year
Date
Full Name
*
First Name
Last Name
Children & ages who will attend service (if applicable)
Contact No.
*
-
Area Code
Phone Number
Email
*
example@example.com
Emergency Contact
-
Area Code
Phone Number
List any allergies
Have you had a fever over 101 in the last 48 hours?
*
Yes
No
Have you experienced cough and cold in the last 48 hours?
*
Yes
No
Have you lost sense of smell and taste in the last 48 hours?
*
Yes
No
Have you experienced shortness of breath in the last 48 hours?
*
Yes
No
Have you thrown up or had diarrhea in the last 48 hours?
*
Yes
No
Have you tested positive for COVID-19 in the last 30 days?
*
Yes
No
Are you awaiting test results from COVID-19 test?
*
Yes
No
To your knowledge, have you been exposed to anyone who has tested positive for COVID-19 in the last 30 days?
*
Yes
No
By presenting yourself and/or your child, you assume and accept the risk that you or your child may be exposed to a communicable disease.
*
Yes
No
Do you acknowledge that you are required to wear a mask at all times while inside of the building?
*
Yes
No
Do you acknowledge and consent to having you and your child(ren)'s temperature checked upon entering the building?
*
Yes
No
We are excited to see you again!
Thank you for your registration and cooperation. Please remain home and continue to watch services virtually if you are feeling sick for any reason. We appreciate your patience and prayers as we navigate through this season and ask that you continue to be understanding and flexible. PLEASE CLICK "SUBMIT FORM" BELOW to complete your registration!
Submit Form
Should be Empty:
Now create your own JotForm - It's free!
Create your own JotForm