Attendance Registration Form - RECENT CHANGES MADE PLEASE READ ALL THOSE PLANNING ON ATTENDING SERVICES AT SHILOH MUST SUBMIT YOUR REQUEST AT LEAST 3 DAYS PRIOR TO YOUR VISIT. IF IT IS RECEIVED LESS THAN 72 HOURS OF YOUR VISIT YOU WILL NOT BE PERMIT TO ATTEND. As the coronavirus (COVID-19) pandemic continues, we are monitoring the situation closely and following the guidelines from the Centers for Disease Control and Prevention and local health authorities. The safety of the church and those attending are high priority. Due to the increase in the number of request to attend services and limitations with social distancing we have developed a Service Attendance Registration Form. In order to prevent the spread of the coronavirus and reduce the potential risk of exposure to our members, we are asking everyone to complete and submit this questionnaire if you desire to attend services. Once it has been received someone from our Medical Staff will contact you with further instructions. We are putting these measures in place for the protection and safety of everyone.Name:* Email* Enter Email Confirm Email Phone Number (mobile/home)* Date to Attend:* Number Attending (Complete form for each adult):*Question #1*If you are experiencing or have experienced in the past 14 days, any of the following symptoms, please check the appropriate box. (If possible, please take your temperature before you answer this question.) Select All Fever (100.4°F /37.8°C or greater as measured by an oral thermometer) Cough Shortness of breath or difficulty breathing Sore throat New loss of taste or smell Nausea, diarrhea, vomiting None of the above. Question #2*In the past 14 days, have you been in the close proximity to anyone who was experiencing any of the above symptoms or has experienced any of the above symptoms since your contact? Yes No Question #3*In the past 14 days, have you been in close proximity to anyone who has tested positive for COVID-19, including your local congregation? Yes No Question #4*Have you been tested for COVID-19 and are waiting to receive test results? Yes No Question #5*Have you tested positive for COVID-19, or are you presumptively positive for COVID-19 based on your health care provider's assessment or your symptoms? Yes No Question #6*In the past 14 days, have you been on a commercial flight or traveled outside of the United States or your residential state? Yes No Question #7*In the past 14 days, have you been in close proximity to anyone who has been on a commercial flight or traveled outside of the United States or their residential state? Yes No Question #8*If you have received the COVID-19 vaccine check the appropriate box below: 1st vaccination 2nd vaccination None of the above Section BreakAll the information that you submit on this form will be maintained as confidential. If you have any questions, please feel free to submit them in the box below. God Bless! All the information that you submit on this form will be maintained as confidential. If you have any questions, please feel free to submit them in the box below. God Bless!Questions/Concerns Consent I agree to the privacy policy.Section Break Δ
