Covid-19 Health Form

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Covid-19 Health Declaration

How are you feeling today?

First Name

Last Name

Email

List names of additional family members that will attend service:

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.

Initials

Thank you for registering!

An acknowledgement email will be sent shortly.

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Sunday Service: 10:00 AM

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680 E. US HWY 80 Mesquite, TX 75149 ~ Phone: 972.329.5030

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