Covid-19 Health Form

The body temperature of everyone listed in my household is lower than 98.6°F/ 37.5°C

No one in my household is experiencing the symptoms: fever, cough, sore throat

None of the people in my household have been in close contact with a Covid-19 patient within the last 14 days

I declare that the info I’ve provided is accurate & complete for all persons listed.

I also declare that if any of these conditions change for someone listed prior to attending worship service, I will notify MFBC and we will not attend in person.

Mesquite Friendship Baptist Church

Covid-19 Health Declaration

List names of additional family members that will attend service: