Saint Dimitrie the New Church - Sign-in sheet during COVID-19 Pandemic
Frederick, CO, United States
Enter ALL NAMES (First & Last) of the persons that are in the group
Phone *
Enter your phone number
Email *
Enter your email address
Group Size *
How many persons in the group. Make sure that ALL the NAMES (First and Last) are entered above
✹ I have not been diagnosed with COVID-19 and I currently do not have symptoms of COVID-19.
✹ I am not a healthcare professional who cares for COVID-19 patients.
✹ I have not been exposed to others who have COVID-19 and I am not caring for anyone with COVID-19.
✹ I am not especially vulnerable to COVID-19 due to age or an underlying medical condition as defined by Health Canada and/or Provincial health authorities.
✹ I have not attended any crowed events/parties/other parishes where social distancing and safety precautions are not in place within the last 14 days.
✹ Wash my hands and maintain two meters social distancing at all times.
✹ Wear a mask at all times (children under 8 years old are not required to wear masks). It is strongly recommended that young children remain at home during the re-opening phases.
✹ Put on a new mask after receiving Holy Communion.
✹ Not to kiss the icons, the chalice, or the priest’s hand.
✹ Follow the directions of the greeters and ushers and remain at my designated spot during the service.
✹ Depart promptly after the service, maintaining social distancing protocols.
According to the health authorities, older adults and people of any age who have serious underlying medical conditions might be at higher risk for severe illness from COVID-19, including:

✹ People with chronic lung disease or moderate to severe asthma
✹ People who have serious heart conditions
✹ People who are immunocompromised
✹ People with severe obesity (body mass index [BMI] of 40 or higher)
✹ People with diabetes
✹ People with chronic kidney disease undergoing dialysis
✹ People with liver disease

While our parish is taking precautions to prevent the spread of COVID-19, we cannot guarantee that you will not become infected. Attending services may increase your risk of contracting COVID-19, especially if you are over 65 year old or have an underlying health condition. By entering, you voluntarily assume this increased risk of exposure or potential infection with COVID-19.
Signature *
Enter your full legal name
Never submit passwords through Google Forms.
This form was created inside of Saint Dimitrie the New Church. Report Abuse