COVID-19 Worship Service Screening Questionnaire
You must fill out this questionnaire each time you want to attend in-person worship services at New Church Westville. When you arrive to attend a service we will verify whether you have filled it out online and if not you will be required to fill it out in person.

We will not use the information supplied for any other purpose than COVID-19 regulation compliance.

Please visit https://sacoronavirus.co.za/ to learn about the dangers of COVID-19 and how to prevent it.
Full Name *
Date of Service You Are Attending *
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Are there any other people from your residence attending the service? (Please list them all.) *
Are you aware of the dangers of COVID-19 and how to prevent it? *
Have you supplied New Church Westville with your full contact information and the contact information of the people you stay with? (contact number, residential address, etc.) *
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