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? *
Required
Within the last 14 days, have you had any contact or exposure to anyone who has tested positive for COVID-19?
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Name *
Phone Number
Emergency Contact Name
Emergency Contact Number
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