Church Attendance Registration

Church Attendance Registration Form

Please fill in the form below.
Full Name *

First Name Last Name
Email
example@example.com
Phone Number *

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State

Zip Code
I will attend: *
How many will be attending with you? (not including yourself) *
5 people maximum in family
Names of Your Attendees:
First and Last Name
Attestation: *

I WILL wear a face mask at all times while on church premises. I WILL keep a safe distance of at least 6 feet from other people. I have NOT experienced any symptoms of COVID-19 in the past 14 days (fever, cough, shortness of breath or difficulty breathing, chills, repeated shaking with chills, muscle pain, sore throat, abdominal pain/diarrhea, or new loss of taste or smell). I have NOT been in close or proximate contact in the past 14 days with anyone who has tested positive for COVID-19 or who has had symptoms of COVID-19. I have NOT traveled to any of the states listed in Governor Cuomo's Executive Order 205 or any international destinations requiring quarantine (as identified by New York State). I did NOT test positive for COVID-19 in the past 14 days.
Required Protocol for Returning On-Site (n.b. you must read all text and scroll to the bottom before you can use the checkbox) *
Signature *

Clear
Notes:
Should be Empty:

Church Attendance Registration Form