Church in LA Corporate Housing Health Protocol Agreement Form
While we believe and trust in the Lord that He will cover us, we also want to be vigilant and do whatever we can to prevent any spread of disease among our community, the church life, and corporate living. This is not a time to panic, but to be prepared in a serious way. Please join us in praying for our health and safety as well as for the Lord's sovereign will to be done on earth.
Name *
Phone number *
Address of your housing unit: *
Do you suspect that you yourself or anyone that you may have had contact with could have Covid-19? *
PREVENTATIVE MEASURES
Please check all of the boxes below indicating your agreement to regularly practice these items both for the sake of ourselves and for our care for one another: *
Required
Where are you planning on going during your spring break? Please list all cities. *
WHAT TO DO IF I AM SICK, HAVE A COLD, AND/OR HAVE FLU SYMPTOMS:
If I have any of the these symptoms: Sore throat, fever, coughing, shortness of breath, respiratory problems, I agree to: *
Required
MY PLANS IF I CONTRACT COVID-19 OR AM EXPOSED TO SOMEONE WHO IS:
I agree to immediately notify my housing coordinator *
I agree to seek immediate treatment from a medical professional. *
I recognize that a 14 day quarantine period is mandatory for anyone who contracts Covid-19 or is exposed to some who has it. *
If necessary, I prefer to be quarantined: *
I acknowledge that the following conditions must be adhered to should I need to be quarantined: *
Required
OTHER IMPORTANT CONSIDERATIONS:
If my classes are canceled or are moved completely online, I would most likely: *
Please check all of the following to indicate your agreement to each statement: *
Required
Do you have any other comments or questions?
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