Informed Consent for In-Person Mass Attendance at St. Anne of the Sunset
To indicate that you understand these risks and agree to abide by all safety protocols and to follow all other instructions that may be given, and that you acknowledge the risks involved
St. Anne parish intends as best it can to follow all mandated Archdiocesan safety protocols and county regulations for public worship services. However, the county medical officer has advised us that public gatherings may nevertheless present an increased possibility of contagion even if safety precautions are taken, and therefore he has asked us to inform you that your participation may increase the risk for yourself and your family.
In particular, if you are over the age of 50 or have a chronic or underlying medical condition, a gathering increases your risk of contracting the virus or if you do contract the virus it may have a greater chance of creating serious illness that could even result in death. If you fall into this high-risk category and/or if you feel sick, are displaying COVID-19 symptoms (especially fever, cough or difficulty breathing) or if any of these symptoms are being experienced by someone in your household, you should stay home. The church cannot guarantee that there is no risk of infection for attendees.
Your signature below indicates that you understand these risks and agree to abide by all safety protocols and to follow all other instructions that may be given, and that you acknowledge the risks involved. This information will be kept confidential to the extent the law allows, and is protected from law enforcement and immigration authorities. Should you desire to share the mass time and date, it will help with contract tracing should the need arise.
Names of family members attending
other family members who will attend with you
THE MASS THAT YOU WILL ATTEND
Date of mass attending
Time of mass attending
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Check to sign form
I am electronically signing this form
Enter full name to sign form
first name, middle initial, last name
A copy of your responses will be emailed to the address you provided.
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