St. Philips Baptist Church                                        COVID-19 Self Screening Questionnaire
There Must Be a Registration Form Completed for EACH Person Attending In-Person Worship Service
PLEASE COMPLETE BY 11:59 PM ON THURSDAY OF EACH WEEK.  THANK YOU.
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Email *
I plan to attend in-person worship service on this date: *
MM
/
DD
/
YYYY
Phone number *
Last Name *
First Name *
Within the past 14 days, have you had any of the following: *
Yes
No
Fever Higher Than 100.4▪
Persistent Cough
Sore Throat
Shortness of Breath
Close Contact w/Anyone w/COVID
Headache
Loss of Taste or Smell
Travelled Outside of the US
FOR FAMILIES AND ACCOMPANYING FRIENDS ONLY:         Use this space to list individual names of family members and friends that will attend in-person worship service and be seated together.  You must attest that the answers provided above are reflective of everyone listed and attending service together.  Everyone else, please submit a separate form.  Thank you.
If you answered 'YES' to any of the above questions, please DO NOT come to church.  You should self-quarantine for at least 14 days and contact your healthcare provider.  You can stream our services on Facebook until you're able to safely return to in-person worship.  Thank you and God bless.
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