EVENTS & ANNOUNCEMENTS

Church Reservation &

Health Declaration

Please fill out the following health declaration form to reserve seating for our Sunday, October 4, 2020 service at 9AM CT.

All submissions will be individually reviewed before reservations are confirmed and all reservations are only valid for the Sunday service requested.

First & Last Name

Phone

How many seats you would like to reserve for you and your immediate family members? There is a limit of 5 seats that can be reserved at this time.

Have you or any one in your home experienced any COVID 19 related symptoms to include coughing, dizziness, fever, diarhea, body aches, lost of taste or smell or a shortness of breath?

Yes

Have you or any one in your home been in contact with some that has tested positive for COVID 19 within the last 14 days?

Yes

Unsure

Date

Your Initials

I confirm that the information given in this form is true

2023Year of the Harvest

EVENTS & ANNOUNCEMENTS

Church Reservation &

Health Declaration

Please fill out the following health declaration form to reserve seating for our Sunday, October 4, 2020 service at 9AM CT.

All submissions will be individually reviewed before reservations are confirmed and all reservations are only valid for the Sunday service requested.

ABOUT US

OUR ACADEMY

ADDRESS

OUR CHILDCARE

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