January 30, 2022 - MBC Registration/Screening Form

Please complete a separate form for EACH person attending.

Name

This address will receive a confirmation email

Phone #

Covid-19 Screening Symptoms:

- Fever or Chills

- Cough

- Shortness of Breath

- Sore Throat or Difficulty Swallowing

- Decreased/loss of Smell or Taste

- Nausea or Vomitting; Diarrhea or Abdominal Pain

- Runny Nose or Nasal Congestion (not realted to allergies or post nasal drip)

- Not feeling well, extreme tiredness, unexplained sore muscles

Do you or ANYONE in your household have any of the symptoms listed above?

If the answer to the question above IS or becomes YES, please stay home.
You can contact York Region Public Health at 1-800-361-5653 or york.ca/covid19.

For the health and protection of all attending, will you (or your 2+ year old child): SANITIZE/WASH hands on arrival and wear a MASK (covering MOUTH & NOSE) while in the Chapel?

Yes

If you are not comfortable following the plans and procedures set-out by the leadership of Markham Bible Chapel, please take advantage of our online meeting option.

Description

Sunday @ 9:30 am

Please fill out this form, one per person, and click submit.

January 30, 2022 - MBC Registration/Screening Form

Description

Please Fix the Following