NMOBC - COVID-19 Screening Form
Please complete this form on the Sunday that you plan to attend church. Forms submitted prior to the Sunday of church service cannot be accepted.
Have you tested positive for COVID-19 within the last 14 days?
Do you feel sick today?
Within the last 14 days, have you had any of the following symptoms?
Fever greater than 100 degrees
Felt like you had a fever
Vomiting or diarrhea
Loss of taste or smell
Within the last 14 days, have you had any contact or exposure to anyone who has tested positive for COVID-19?
Emergency Contact Name
Emergency Contact Number
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