Name (Required)

Phone Number (Required)

Email (Required)

1. I know that it is possible to be exposed to COVID-19 and other infectious diseases by attending. (Required)

2. I know there is a risk of serious illness and possible death, even with rules and personal precautions. (Required)

3. I knowingly and freely assume all such risks and release Family Worship Center, its workers and volunteers of responsibility. (Required)

4. I have had a positive COVID-19 test in the past 14 days (Required)

5. I am waiting on results of a COVID-19 test. (Required)

6. I have come into close contact with someone who has COVID-19 in the past 14 days. (Required)

7. Within the past 14 days, I have been told to self-monitor,self-isolate, or self-quarantine. (Required)

8. I have traveled in the past 14 days. (Required)

9. I will use the Main Entrance to Enter/Exit. (Required)

10. I understand that Temperature Checks and other Covid Safety Measures such as Masks, 6ft Social Distance, etc. are REQUIRED. (Required)

11. I will remain in the Sanctuary and Front Vestibule areas, bathrooms included. (Required)

12. I have fever or chills. (Required)

13. I have a cough. (Required)

14. I have shortness of breath or difficulty breathing. (Required)

15. I have a headache. (Required)

16. I have a loss of taste or smell. (Required)

17. I have a sore throat. (Required)

18. I WILL KEEP MY MASK ON. (Required)

19. I WILL MAINTAIN SOCIAL DISTANCE. (Required)

20. I WILL NOT LIVESTREAM SERVICE. (Required)

21. I WILL NOT RECORD SERVICE. (Required)

22. I grant FAMILY WORSHIP CENTER the right to record/ photograph my image, likeness, voice, etc. for the purpose of this service, any marketing and/or publicity campaigns. (Required)

23. I understand that I will NOT be compensated (paid) in any way for the recording and/or use of my image, likeness, voice, etc. (Required)