2022 Spring: MZAC Toronto COVID-19 Health Disclosure Declaration

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This form is for Sunday morning services and Monday night bible class as of May 13, 2022 and must be completed every week.

NOTE - As of April 11, 2022: Although various restrictions have been lifted by the Ontario government, this registration form is still required if entering for service to consider the health and safety of others as COVID-19 is still present in our communities.

Prior to entering 30 Pemican Court, please consider the health and safety of others. Access to the building will not be granted for anyone who has either not completed this form or if you cannot "confirm" for all items listed below. Please complete one form per person.

Thank you for your cooperation.

Email *

Contact phone number *

Full Name *

Which service(s) will you be attending? *

Sunday morning worship

Monday night bible class

Required

Please review and confirm the following: *

I confirm

I do not confirm

I am not currently experiencing any symptoms consistent with COVID-19

I do not live with anyone experiencing symptoms, who have been in close contact with or is waiting for test results for COVID-19

I have not been diagnosed or presumed positive with COVID-19

I have not been told by a doctor to self isolate

I have not been in close contact with a confirmed or probable COVID-19 case

I have not travelled anywhere outside of Canada, or have been in contact with anyone who has travelled outside of Canada in the last 14 days.

I am not waiting for the results of a COVID-19 test

I confirm

I do not confirm

I am not currently experiencing any symptoms consistent with COVID-19

I do not live with anyone experiencing symptoms, who have been in close contact with or is waiting for test results for COVID-19

I have not been diagnosed or presumed positive with COVID-19

I have not been told by a doctor to self isolate

I have not been in close contact with a confirmed or probable COVID-19 case

I have not travelled anywhere outside of Canada, or have been in contact with anyone who has travelled outside of Canada in the last 14 days.

I am not waiting for the results of a COVID-19 test

Send me a copy of my responses.

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