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. Proof of vaccination and Facemasks are required. You can submit proof of vaccination by scanning your vaccination card or taking a picture of it and emailing it to elmwoodupc@gmail.com. You can also drop off a copy of your vaccination card to our church office or bring to the worship service. Once you have provided a copy of your card, it will be placed on file for future reference. There is no need to provide a copy every time you register to attend a service.

We strongly encourage you to arrive at church before 9:15 a.m.

NOTE: Children must register and are allowed to sit in the sanctuary with their parents. Or they can sit in the fellowship hall and view the service.

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eupc_service_pre-registration_form_rev._9.21.21.pdf
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DATE(s) OF SERVICE(s) YOU ARE REGISTERING FOR: *

Name *

First

Last

Please list the name of other attendees:

Name *

First

Last

Name *

First

Last

Name *

First

Last

Name *

First

Last

Name *

First

Last

Name *

First

Last

Please provide the preferred contact number:

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.

Once you submit your form, you will get a message "Thank you. Your information has been submitted and you will receive a confirmation email".

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