加略山證道浸信會9月27日會友會 CLBC Members Meeting: September 27, 2020
Email address *
I give permission to CLBC to collect and retain the information I share on this form, and share with Public Health for contact tracing purpose. 本人同意加略山證道浸信會收集及保留此表格內之個人資料,並可提供給公共衛生機構以作追蹤之用途。 *
Your Full Name 姓名 *
Your contact number 聯絡電話 *
1. Do you have any of the signs or symptoms of COVID-19? 你有下列任何新型冠狀病毒之症狀嗎? *
Required
If answered YES to any of the above, please hold off on coming to church and stay home until well. 如果對以上任何一項的答案為"是",請留在家中直至康復
2. Have you been tested for COVID-19? 曾否接受新型冠狀病毒檢測 *
If tested for Covid-19, what is the result? 若曾接受檢測,結果是什麼?
Clear selection
3. Have you been travelling outside of Canada in the past 14 days? Have you had close contact with someone who are tested positive for COVID-19? 在過去十四天內有否到加拿大以外的地方旅遊?曾否與新型冠狀病毒確診者密切接觸? *
4. If you are instructed by Public Health to self-isolate, have you completed the 14-day quarantine period by the date of members meeting? 如公共衛生指示要自我隔離, 在會友會當天你是否已經完成14天自我隔離? *
If you pass the self-screening, please wear a face mask/face covering and maintain 6 ft physical distancing while on church premises, including chapel, hallways, parking lot etc. Do you need a face mask provided by church? 如果通過自行測試,請於出席聚會時, 在教會走廊及停車場時, 戴上口罩或面罩,並保持6呎社交距離。你需要教會提供口罩嗎?
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