*TEST Antioch Baptist Church North Worship Service Reservation

Antioch Baptist Church North Worship Service Reservation

Sunday August 7, 2022 - 10:00 AM
This form allows a maximum of 4 Registrations. If you require additional registrations, please submit an additional form.
Date of Service

Month Day Year
Number of Seats Needed *
Full Name *

First Name Last Name
E-mail *

Confirmation Email example@example.com
Phone Number *
I acknowledge that I am fully vaccinated. Acknowledge by selecting "Yes" or "No"
Covid 19 Symptoms *

I agree that I am not experiencing COVID symptoms, have not recently been exposed to someone with COVID, and do not believe to be infectious.
Enter the contact information for each additional person *
If the number is only 1 person no additional contact information is needed.
Enter the contact information for each additional person
Name of 2nd Person *

First Name Last Name
I acknowledge that I am fully vaccinated. Acknowledge by selecting "Yes" or "No"
Covid 19 Symptoms - 2nd Person *

I agree that I am not experiencing COVID symptoms, have not recently been exposed to someone with COVID, and do not believe to be infectious.
Name of 3rd Person *

First Name Last Name
I acknowledge that I am fully vaccinated. Acknowledge by selecting "Yes" or "No"
Covid 19 Symptoms - 3rd Person *

I agree that I am not experiencing COVID symptoms, have not recently been exposed to someone with COVID, and do not believe to be infectious.
Name of 4th Person *

First Name Last Name
I acknowledge that I am fully vaccinated. Acknowledge by selecting "Yes" or "No"
Covid 19 Symptoms -4th Person *

I agree that I am not experiencing COVID symptoms, have not recently been exposed to someone with COVID, and do not believe to be infectious.
The registration process declined due to your selection of “No” to the question above. By selecting “No” you are stating that you do not meet the current requirements to attend in-person worship service. We look forward to you joining us virtually.
Do you require special entry accommodations due to the use of a wheelchair and/or walkers? *
Please utilize the Fellowship Hall entrance when you arrive. We look forward to seeing you!
Based on the selections above you are not able to submit this form and will not be able to register for our In-Person Worship Service
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