New Life Church Attendance Questionnaire
This form must be completed Sabbath morning for any person who desires to attend worship service at New Life Seventh-day Adventist Church. You may complete one questionnaire per household if you list all household members who plan to attend in the space provided. If you are able to answer yes to any of the questions concerning you or any member of your household, you are asked to stay at home, and you will not be admitted into the building. Temperatures will be taken at the door.

All worshipers are required to wear face coverings at all times while in the church building.
Name (First and Last) of person completing the questionnaire *
Best contact Phone Number *
Names (First and Last) of other household members who will be in attendance
Have you or any of your household members experienced any of the following: *
Yes
No
Flu symptoms, fever, cough, shortness of breath or sore throat in the last 48 hours
Loss of taste or smell, vomiting or diarrhea in the last 48 hours
Close contact with anyone testing positive for covid-19 in the last 14 days
Traveled (overnight trip) on public transportation or with any people who are not in your household in the last 14 days
Quarantining because you may have been exposed to covid-19
Currently waiting on the results of a covid-19 test
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