Health Acknowledgement Form
Bishop Lewis announced the cessation of in-person worship in Virginia due to COVID-19 in March of 2020 after significant prayer and thoughtful consultation with experts in the religious, legal, and scientific communities. Her closure of our churches was done with the singular goal of saving lives and keeping individuals and their communities healthy, as we did our part as United Methodists to help stop the spread of the novel coronavirus.

In late April, Bishop Lewis formed a workgroup that consulted professionals and resources from a variety of disciplines to develop plans and procedures for resuming in-person worship and gatherings in churches with the same goal of keeping individuals and their communities healthy and safe.

This form is a product of Shady Grove UMC - Short Pump and serves as a Health Acknowledgement Form that is part of the Virginia plan and procedure for returning the conference to in-person worship and gatherings with the safety of all in mind.

When you fill out this form, it will be on-file and current for seven (7) days after the date submitted. You will be asked to confirm that the information you have provided is still accurate when you arrive at church for worship and other gatherings. To be sure you may attend weekly worship and ministry opportunities, please complete a new registration form each week.

PLEASE NOTE: To register for worship or to signal your intent to participate in other gatherings, please register on Realm or follow other directions given by member of SGUMC Staff.
Last Name *
First Name *
List ALL family members if able to answer the same for all health questions
Email *
Phone *
Gatherings to attend in the next 7 days *
This form is valid for one week, so must be completed on a weekly basis for any in person gathering. Select all gatherings that you may be present for in the next 7 days. ***Please note you must also register on Realm or as otherwise directed by SGUMC Staff for each gathering/event that you will attend, this will help us expedite check-in.
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