SPCC In-Person Worship Registration

Please complete the form below to pre-register for the Worship Service. This form is designed to expedite screening/check-in protocols, ensure safety of volunteers, employees, and guests, and to establish contact tracing information for all persons entering the building.

1) Have you:*

	Yes	No	Under 5 years old
Been fully COVID Vaccinated (i.e., 2 doses, and boosted if 5 months since last shot), or tested negative for COVID in the last 48 hours

2) Have you had any of the following symptoms in the last 24 hours?*

	Yes	No
Cough
Shortness of breath of difficulty breathing

3) OR had any of the following symptoms in the last 24 hours:*

	Yes	No
Fever (usually 100.4 or higher)
Chills
Repeated shaking with chills
Muscle pain
Headache
Sore throat
New loss of taste or smell

4) In the last 7 days have you:*

	Yes	No
Been in contact with someone who was diagnosed with COVID-19?
Been in close contact with someone who had COVID-19 symptoms?

Note: If you have not test NEGATIVE for COVID in the last 48 hours or You have not been vaccinated (i.e., 2 doses and current on boosters). Please consider joining us for our virtual service at: facebook.com/spccdoc

If you are asymptomatic, or been exposed to someone with COVID in the last 7 days, please join us online.

Note: One registration form is required per person. Parents/guardians should complete forms for persons under 18.

Name*

First NameLast Name

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Planned Service Attendance Date

Date

Note: If you have not test NEGATIVE for COVID in the last 48 hours or You have not been vaccinated (i.e., 2 doses and current on boosters). Please consider joining us for our virtual service at: facebook.com/spccdoc

If you are asymptomatic, or been exposed to someone with COVID in the last 7 days, please join us online.

Shepherd Park In-Person Worship Registration