Progressive Baptist Church

Progressive Baptist Church
In Person Service Registration
Registration and completing a screening questionnaire is required every time you attend Sunday service. The form needs to be completed between Friday or Saturday before attending Sunday service. Please take a few minutes to complete the questionnaire.
Click if you plan to attend Sunday service in person.*
Sunday 11/22
Number of people planning to attend in person service including children.*
Enter name of all people planning to attend in person service including children.
Person 1 Name*
First NameLast Name
Person 2 Name
First NameLast Name
Person 3 Name
First NameLast Name
Person 4 Name
First NameLast Name
Person 5 Name
First NameLast Name
Person 6 Name
First NameLast Name
Contact Email Address
Contact Phone Number
Please enter a valid phone number.

	Yes	No
1. Does anyone in your group have fever greater than 99.5 F?
2. Has any one in your group experienced shortness of breath or had trouble breathing?
3. Does anyone in your group have a dry cough?
4. Does anyone in your group have a runny nose?
5. Has anyone in your group recently lost or had a decrease in your sense of taste or smell?
6. Does any one in your group have a sore throat?
7. Has anyone in your group tested positive for Covid-19?
8. Has anyone in your group tested for Covid19 and are waiting for the test results?
9. Has anyone in your group been in contact with anyone tested positive for Covid-19?
10. Has anyone in your group been in contact with anyone tested for Covid-19 who is waiting for Covid -19 test results?
11. Has anyone in your group traveled within the United States in the past 14 days.
12. Has anyone in your group been in contact with anyone who as traveled within the United States by air, bus or train within the past 14 days?
13. Has anyone in your group traveled outside of the United States in the past 14 days?
14. Has anyone in your group been exposed to anyone who has traveled outside of the United States in the past 14 days?