Back-to-Church Registration Form

This form lets churches register congregants returning to in-person worship, capturing contact details, health information, and an emergency contact.

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Name

First Name

Last Name

Phone Number

You are a

Member Visitor First-time guest

Have you been fully vaccinated for COVID-19?

Yes No

Will other people be attending the worship service with you?

Yes No

Do you have any health conditions?

Yes No

Please give details about your underlying health conditions

Emergency Contact Name

First Name

Last Name

Phone Number

I, the undersigned, agree with the following statements:

I confirm the information provided is accurate I agree to follow the church's health and safety guidelines during the service

Date

Signature

Sign here

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