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Mount Vernon SDA Church COVID-19 Tracking Tool
Information in this tool will be used for contact tracing only.
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* Indicates required question
Email
*
Your email
First Name:
Your answer
Last Name:
*
Your answer
Phone Number:
*
Your answer
Date you will be joining us?
*
MM
/
DD
/
YYYY
Please share the nature of your visit
*
Choose
Event Production
Worship Service
Rehearsal
Funeral
Soup Kitchen
Wedding
Other
Department/Guest:
Your answer
Do you have any of the following symptoms:
*
Headaches
Cough
Shortness of Breath of Difficulty Breathing
Body Aches or Pains
Rashes
Adominal Pain with Nausea, Vomiting, or Diarrhea
Loss of Appetite or Loss of Taste or Smell
Any Redness or Swelling in your Toes
NONE of the Above
Required
Have you traveled outside of the United States in the last 7 days?
*
Yes
No
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