Zen Center Visitors Registration Form 精舍訪客登記表
Please fill out the following form to register to visit Chung Tai Zen Center of Houston. If you would like to bring friends, please ask them to register as well. Once you submit the form, WE WILL REVIEW AND CONTACT YOU WITH A CONFIRMATION BY EMAIL.

Please review these COVID-related restrictions. We would ask you to delay your visit if any of the following are false.

1. I have not recently experienced any of the following symptoms: fever of 100.4F or greater, cough, sore throat, shortness of breath or difficulty breathing, chills, muscle aches, headache (not attributed to a chronic condition such as a migraine), new loss of taste or change in taste or smell, or other symptoms of illness.
我最近沒有以下症狀: 發燒超過華氏100.4度,咳嗽,喉嚨痛,氣短或呼吸困難,發冷,肌肉酸痛,頭痛(非慢性疾病所引起的頭痛如偏頭痛),最近剛發生味覺的喪失或有味覺、嗅覺的改變。其他感冒症狀。

2. I have not been in close contact with anyone who has been confirmed positive for COVID-19 within the past 14 days.

3. I have not been in close contact with anyone who is experiencing symptoms of COVID-19 but is not yet to be confirmed within the past 14 days.

4. I have not been instructed by a health care provider or public health authority to be under home quarantine within the past 14 days.
在過去14天內, 沒有醫療提供者或公共衛生機關指示我在家隔離。

5. I have not been confirmed positive for COVID-19 in the past 14 days.

6. I have not traveled outside the country or on an airplane within the past 14 days.

7. I agree to the Zen Center's requirements, including: wearing masks, social distancing, taking of temperature, filling out questionnaire and consent form. I also agree that I voluntarily assume the risk that I may be exposed to or infected by COVID-19 in the Zen Center and I waive any liability against the Zen Center and any other parties.
Sign in to Google to save your progress. Learn more
By agreeing, you affirm that the above statements are true. 點選「我同意」代表我確認以上的陳述都是真實無誤的。 *
Name 姓名 *
Email 電子郵件信箱 *
Phone Number 電話號碼 *
Date you would like to visit 您想參訪的日期
Have you joined the meditation classes in the Zen Center before? If yes, about when? 您參加過精舍的課程嗎?如果有,大概多久以前? *
Are you interested in the online Buddhist class and in person meditation workshop (with masks) 您對於線上佛法課程以及來精舍靜坐共修有興趣嗎? *
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy