ATTENDANCE PRE-REGISTRATION FORM
******PLEASE SUBMIT THE FORM NO LATER THAN 9:00PM ON TUESDAYS AND YOU MUST RECEIVE CONFIRMATION BEFORE YOU ATTEND IN-PERSON.*********
NAME (Please include your middle initial): *
Age Range: *
ADDRESS: *
TELEPHONE NUMBER: *
EMAIL ADDRESS:
LAST DATE YOU ATTENDED CHURCH:
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Do you currently have or have you experienced within the last 10 days any of the following (check all that apply): *
Required
In the past 10 days, have you gotten a lab confirmed positive result from a COVID-19 diagnostic test that was your first positive result OR was AFTER 90 days from your previous diagnosis date? *
Are you considered fully vaccinated against COVID-19? (To be considered fully vaccinated by CDC guidelines, two weeks must have passed since you received the second dose in two dose series or two weeks must have passed since you have received a single dose vaccine.) *
Have you travelled to another state or internationally in the past 10 days? *
To the best of your knowledge, have you been in close contact (within 6 feet for at least 10 minutes over a 24-hour period) with anyone who is currently diagnosed with COVID-19 or anyone has exhibited symptoms of COVID-19? *
I hereby certify that the above statements are true and correct to the best of my knowledge. *
Required
Print Name (indicating signature) *
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