Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Testing
*
I received a positive COVID-19 test
Date of Test
*
-
Month
-
Day
Year
Date
Contact with Others
*
I recently attended a Cross City event (Worship, Connection, or other)
I was at the event 48 or fewer hours before my test
I was at the event 48 or fewer hours before my first CDC-defined COVID-19 symptom
I was at the event within 10 days AFTER my test
I attended multiple Cross City events that meet any of the above criteria
Name of Event
*
Event Campus/Ministry
*
Please Select
8:30 Traditional Worship Service
11:00 Worship Service
North
International
Español
Preschool
Kids
Students
Singles
Adults 18-49
Adults 50+
Missions
Worship
Other
Date of Event
*
-
Month
-
Day
Year
Date
List of people with whom you had close contact
*
Close contact is considered to be within 6 feet for more than 10 total minutes in any 24 hour period.
Submit
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