Faith UCC Worship Registration/COVID Screening
Please fill out a separate COVID screening form for EACH family member wishing to attend.
Our maximum capacity for church at this time is 75 people which includes the Pastor, organist, musicians, lay readers, ushers, and stream team. When we reach the maximum, registration will be closed.
Date of requested service
LAST Name (Please register each family member separately)
FIRST Name (Please register each family member separately)
Do you have a household member or close contact who has been diagnosed with COVID 19 in the past 2 weeks?
Yes (If you answer yes, please stop now and plan to use an alternative option for watching or listening the service.)
Are you experiencing any symptoms consistent with COVID 19? (Not seasonal allergies -If you check anything other than No Symptoms please stop now and plan to use an alternative option for watching or listening to the service.)
Shortness of breath or trouble breathing?
Shortness of Breath
New Taste of Loss or Smell
Muscle Pain and Body Ache
Diarrhea or vomiting
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service