KW SDA COVID SCREENING FORM
This form is designed for anyone who wants to attend  church in person. This form is to be completed BEFORE registering for attendance at the Kitchener-Waterloo Seventh-day Adventist Church. This form is to confirm if you are cleared to register. At the present time there is a limit on the number of people who  will be able to register for attendance. Masks  and social distancing are still required. We provide hand sanitizer. YOU HAVE TO REGISTER AFTER SUCCESSFULLY COMPLETING THIS CLEARANCE FORM. PLEASE NOTE that  despite the precautions taken for attendees at church, in relation  to COVID-19 and its variants, that the church cannot guarantee that the building is COVID-19 free .
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Do you have a fever *
Do you have any of the following symptoms? *
Required
Contact Info *
Yes
No
Have you had close contact with a person who has a respiratory illness or may have a probable or confirmed case of COVID-19?
Have you travelled or have you had close contact with anyone who has travelled outside Canada (including USA) in the past 7 days?
Did you have a laboratory exposure to biological material (i.e. primary clinical specimens, virus culture isolates) known to contain (COVID-19)
Did you have close contact with a person who had an acute respiratory illness that started within 7 days of their close contact to someone with a probable or confirmed case of COVID-19
Do you have any of the symptoms listed above or answered yes to any of the above questions ? *
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