LIVE - Sunday Worship Registration

• Date of Service*
  MM

  /

  DD

  /

  YYYY
• Name*
  First Name

  Last Name
• Number Attending*
• Your E-mail*
   
• Contact Phone Number
   

  (###)

  -

  ###

  -

  ####
• Have you traveled outside of Canada within the last 2 weeks?*
  Yes

  No
• Do you have any of the following new or worsening symptoms or signs? Fever, cough, shortness of breath, sore throat, runny nose, sneezing, or nasal congestion (not related to seasonal allergies) difficulty swallowing, loss of taste or smell, nausea/vomiting, diarrhea, abdominal pain, not feeling well, chills or headache.*
  Yes

  No
• Have you had close contact with anyone with respiratory illness or a confirmed or probable case of COVID-19?*
  Yes

  No