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Health Acknowledgement Form

These questions are to screen people who could transmit the virus causing COVID-19. The information will remain confidential and reviewed only by the pastor(s), the healthy church team, or the Department of Health for possible contact tracing. Persons who have 2 or more of the listed symptoms or who have been in contact with anyone experiencing symptoms of COVID-19 in the past 14 days are encouraged to worship online only.

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Desired Participation


Please check any of the following symptoms you are experiencing, or have experienced during the past 14 DAYS:

COVID-19 Testing

Did You Bring Children?