Covid-19 Screening Questionnaire
Please fill in this form if you are attending church.
Name and Surname (Please add names of all family members coming here) *
Temperature Reading/s below 38 deg C (to be completed by our team on your arrival at church)
Date today *
MM
/
DD
/
YYYY
Contact number *
Do you or any of the members of your family have any of the following symptoms? *
Required
Has anyone in your immediate family been in contact with someone who tested positive for Covid-19 in the last 14 days? *
Have you (or those in your household) travelled outside the country in the last 14 days, or been in contact with international travellers? *
I understand that attending a gathering of people is a health risk during the pandemic and I acknowledge that I take full responsibility for my attendance, absolving Ridgeway Church of liability. I will also ensure that I social distance and wear my mask at church at all times. *
I grant my permission for Hope Ridge Church to collect, store and process the personal information on this form for Covid-19 compliance and for church-related communication. (No information will be shared with 3rd parties). *
Required
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