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)
Do you or any of the members of your family have any of the following symptoms?
Shortness of breath
Sore or red eyes
Loss of smell or taste
Nausea, vomiting or diarrhoea
Runny or congested nose
None of the above
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.
Yes, I acknowledge and accept
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).
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