Church Attendance Registration Form
Please fill in the form below.
Street Address Line 2
District of Columbia
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
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)
Should be Empty:
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