*FACE MASKS ARE MANDATORY FOR ON-SITE SERVICE

*COVID SELF-ASSESSMENT - In line with provincial regulation and public health guidance, Christian Victory Church is requiring anyone attending an onsite service to complete a COVID-19 health screening by conducting a self-assessment the day of your visit.

Self-Assessment for Workers

ONLINE REGISTRATION

(All information will remain confidential and will not be released beyond the church office)

Date of Service Attending

YYYY

Name

First Name

Last Name

Name

First Name

Last Name

Child(ren)

If in attendance please list child(ren) name and age.

Phone

(###)

###

####

I will do a self-assessment for Covid-19 symptoms the day of my visit. I will reschedule my visit if I have any symptoms or have come in contact with someone that has tested positive. A link to a sample of Self-Assessment Questions can be found at the top of this page.

Yes