KEEP IT SIMPLE group-Mondays 10am
Your anonymity is extremely important and respected. This form is highly confidential unless requested by public health Canada for contact tracing purposes.
All submission forms will be deleted after 30 days from the date of meeting
Please submit this form prior to each Monday morning meeting.
Feel free to copy and save the link -
Date of KIS meeting you are attending
Full Name (confidential)
Do you have any of the following symptoms?
Shortness of breath/difficulty breathing
New or worsening cough
Unusual runny or congested nose
Unusual Sore throat
Loss of smell or taste
Have you or someone you have close contact with recently been tested for Covid-19 and waiting for results?
Are you or someone you have close contact with currently under a 10-14 day quarantine?
Have you or someone you have close contact with traveled outside of Canada in the past 14 days?
IMPORTANT: if you have answered YES to any questions or have any symptoms listed above, please DO NOT click “submit” and respectfully do not attend our meeting.
Self isolation and seeking medical attention is recommended.
PLEASE READ!!! Special reminder: CHURCH RULES, NO PAPER COFFEE CUPS ALLOWED. Please bring a travel mug for coffee! Thank you 🙏🏻
Please bring your own 12&12 (also available for purchase)
No coffee is permitted to be made for meetings
Max 10 PEOPLE allowed while in the “red zone” or “grey zone” (lockdown) and 35 people maximum when not. First come first serve, regardless of form submission.
Once capacity is reached, the doors will be locked. Signage will be posted on the door to text a listed KIS member so that a volunteer can trade spots with them and be of service to anyone in need of an in person meeting
To accept a monthly or desire chip, chips will be placed on the chairperson table to be accepted by members
The 7th tradition basket will be walked around for collection instead of being passed around
No exiting and reentering permitted please
Please do not move the socially distanced chairs and stay in the first chair you choose
Please check off EACH box to confirm you will abide by these mandatory protocols in order to keep our doors open to anyone in need.
Mandatory contact tracing forms must be completed on line or in person before entering the meeting room
Maintain and respect social distancing at all times
Masks are mandatory and to be worn AT ALL TIMES. Failure to do so will be kindly acknowledged by the chairperson out of respect for everyone in attendance
Use a travel mug instead of bringing paper Timmy’s or Starbucks cup
Please Hit SUBMIT below in lieu of signature. By submitting this form, you confirm the completed information above to be true.
If you have answered NO to all applicable questions, do not exhibit ANY possible Covid-19 symptoms and checked off ALL healthy and safety protocols, we look forward to seeing you Monday at 10am! Thank you 🙏
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