Check In Form

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Check In Form

This form is to keep a record for legal purposes and must be filled out by each member after each service.
Please fill this out one per household.

Your attendance will be recorded, including your current phone number, so that should
contact tracing be necessary, the parish will have a clear record of who was present for
each service to comply with the California Contact Tracing Program.

In the event someone who attended the church service with you tests positive for COVID-19 you will be contacted by a public health worker and your health monitored for 2 weeks. The list of attendees will always remain private as will any person who may test positive for COVID-19. Privacy of potentially affected individuals must never be shared (even with spouses) and be maintained by Clergy and Office staff who may have access to private data.

Last Name: *

First Name: *

Please only fill out this form once per household each Sunday

Additional members of household

This is where you would list your children and other members of your household. (This section is not required if you are only one person)

What is your phone number? *

Have you or anyone in your household experienced any symptoms of COVID-19? *

Symptoms may appear 2-14 days after exposure to the virus. Symptoms include fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headaches, new loss of taste or smell, sore throat, congestion or runny nose, nausea, vomiting, or diarrhea. This list does not include all possible symptoms. CDC will continue to update this list as we learn more about COVID-19. https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html

Yes

Thank you for attending today's service by wearing a mask, practicing social distancing, and following all guidelines. Remember to check in each service.

Please remember if you are sick to stay at home and to actively monitor for symptoms of COVID-19.
Services will continue to be live-streamed and policies will be updated on our information website.

https://sites.google.com/view/stgeorgeorthodoxchurch/home

Remember to check for updates and follow any given guidelines including checking in on this google form each service.

God Bless you all

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