Temple Baptist Church
Sunday morning screening and sign up

December 20, 2020
Service time you will be attending *
Last Name: *
First Name: *
How many people in your party? *
Names of additional people in your party:
Your email address or phone number (for contact tracing, if necessary): *
Has anyone traveled outside of Canada in the past 14 days? *
In the past 14 days has anyone tested positive for COVID-19 or had close contact with a confirmed case of COVID-19? *
Does anyone in your group have any of the following symptoms? Fever • New onset of cough • Worsening chronic cough • Shortness of breath • Difficulty breathing • Sore throat • Difficulty swallowing • Decrease of loss of sense of taste or smell • Chills • Headaches • Unexplained fatigue/malaise/muscle aches (myalgias) • Digestive issues (nausea/vomiting, diarrhea, abdominal pain) • Pink eye (conjunctivitis) • Runny nose or nasal congestion without other known cause • For young children and infants: sluggishness or lack of appetite *
Lambton Public Health's regulations have recently changed People are now required to wear a mask while they are inside the church building. I/We agree to wear a mask while inside at all times at Temple Baptist Church. *
If you or others in your group develop any of these symptoms before the event, you will agree not attend. *
If you or others are starting to show signs or symptoms of COVID-19 after attending an in-person church meeting, consult a healthcare professional and notify your church leadership. *
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