Service Pre-Register post covid

• Your Name*
  First Name

  Last Name
• How many others will be with you, The symptom checklist applies to them as well.
• Please provide one piece of contact information
• Phone Number
   

  (###)

  -

  ###

  -

  ####
• Your E-mail
   
• Are you currently experiencing any of these symptoms?
  Check the box if it applies to you
  Fever or Chills

  Cough (whistling or barking)

  Sore Throat
• Have you recently been in contact with anyone who has had COVID-19, or someone who has been sick with fever, chills, or a cough?
• Have travelled outside the province or country within the last 14 days?
• None of the above
• Please read over the following statement
  "If you have checked off any of these five questions, out of love for others, we respectfully cannot allow you into our in-person service. Rather, we would encourage you to check out our online service on Facebook, website, or Youtube. Following a 14-day isolation period we would then welcome you to join us for an in-person service."
  
  Dont forget to bring face masks to services
  
  If you have not already done so please read over the disclaimer at the top of this page
  
  Thank You
• I have read the above statements and disclosures*
  Check box