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22 Coulter Avenue, Pawling, NY 12564
Saturdays 9:30 Bible Class
Saturdays 11:00 Worship Service
Please pre-register each time you attend to let us know that you are coming and to help us keep an accurate log.
Date you are attending
Name
Names of additional people in your group
Email
Cell Phone
I agree to the following:
Practice social distancing by remaining 6 feet apart
No hugging, handshakes, or any other physical contact
Everyone in the building over the age of two must wear a Mask at all times (masks will be provided for those who do not have)
Children twelve and under must be accompanied to the bathroom
HAVE YOU KNOWINGLY BEEN IN CLOSE OR PROXIMATE CONTACT IN THE PAST 5 DAYS WITH ANYONE WHO HAS TESTED POSITIVE FOR COVID-19 OR WHO HAS OR HAD SYMPTOMS* OF COVID-19?
Yes
No
HAVE YOU TESTED POSITIVE FOR COVID-19 IN THE PAST 5 DAYS?
Yes
No
HAVE YOU EXPERIENCED ANY SYMPTOMS* OF COVID-19 IN THE PAST 5 DAYS?
Yes
No
HAVE YOU IN THE PAST 5 DAYS TRAVELED OUTSIDE THE COUNTRY?**
Yes
No
Contact in case of an emergency:
*Symptoms of COVID-19: Cough, shortness of breath or difficulty breathing, fever, chills, muscle pain, sore throat, or new loss of taste or smell. If you have any symptoms please contact your healthcare provider for assessment and testing.
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