EUPC Service Pre-Registration Form

EUPC SERVICE PRE-REGISTRATION FORM

Please complete the questionnaire if you plan to attend our live worship service. Attendance will be limited to ensure physical distancing so please submit your form by Thursday at 12:00 p.m. Facemasks are required, and we strongly encourage you to arrive at church before 9:15 a.m.

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eupc_service_pre-registration_form.pdf
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Name *

First

Last

Please list the name of your spouse and/or child(ren) who will be coming with you. (Symptom checklist applies to them as well).

Name *

First

Last

Name *

First

Last

Name *

First

Last

Name *

First

Last

Name *

First

Last

Name *

First

Last

Home Number *

Cell Number *

Email *

Please answer the following questions:

In the last 14 days, have you tested positive for COVID-19? *

Yes No

In the last 14 days, have you been in close contact with anyone who: tested positive for COVID-19, been told to self-quarantine or waiting for COVID-19 test results? *

Yes No

In the last 14 days have you experienced any symptoms (not due to pre-existing condition) such as fever, cough, shortness of breath, sore throat, nausea, vomiting, diarrhea, or loss of taste or smell? *

Yes No

In the last 14 days, have you or anyone in your household traveled outside the United States? *

Yes No

If you answered yes to any of these questions, out of an abundance of caution, we respectfully ask that you do not attend service in person. Please join us online via our website or Facebook Live.

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