Jones Memorial Baptist Church In-Person Registration Form
To ensure the health and safety of all worshippers, registration for in-person workship is required and is on a "first come - first served" basis. For the purposes of contact tracing, this information is being collected. We will comply with all HIPAA regulations regarding protected personal information. Upon arrival, COVID screening will be conducted. You are asked to be compliant with all instructions. ALL ATTENDANTS WILL BE REQUIRED TO WEAR MASKS.
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Name *
Phone number *
Email *
Date of Attendance *
Have you been fully vaccinated? (Must present vaccination card upon arrival) *
Have you experienced any of the following symptoms in the last 48 hours? Please note: If you have had any of the below symptoms in the last 48 hours, DO NOT physicallly return to in-person worship, but join us via FB Live. *
By registering for in-person worship, I attest to the following: I do not have an active diagnosis of COVID-19; No one in my household has an active diagnosis of COVID-19 nor are they exhibiting any of the symptoms above; I have not had close contact with anyone who has an active diagnosis of COVID-19 or are exhibiting any of the symptoms above. *
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