Children's Church In-Person Registration

1

Parent/Guardian Name* This field is required.

First Name

Last Name

2

Phone Number* This field is required.

Area Code

Phone Number

3

Parent/Guardian Email* This field is required.

example@example.com

4

Child's Name* This field is required.

First Name

Last Name

5

Child's Birth Date* This field is required.

6

Child's Age* This field is required.

7

Child's Grade* This field is required.

8

Name of School* This field is required.

9

Student E-mail

example@example.com

10

Please indicate which service your child plans to attend.* This field is required.

10:00am- In-Person Service

11

Has your child (or anyone in your household) tested positive for Covid-19 in the last 14 days?* This field is required.Please answer honestly. Answering YES doesn't automatically disqualify you from attending worship.

Yes, my child or someone in my household tested positive for COVID-19

No, my child or someone in my household have not tested positive for COVID-19

12

Has your child been told to quarantine because someone in their classroom tested positive for Covid-19?* This field is required.

YESNO

13

Has your child had contact with someone who is Covid-19 positive?* This field is required.

YESNO

14

What actions did you or your child take after exposure to COVID-19?* This field is required.

Took COVID-19 test and the results were negative.

Practiced self-quarantine for 14 days.

15

Is your child feeling ill?* This field is required.

YESNO

16

Does your child have a new or worsening cough?* This field is required.

YESNO

17

Has your child complained of or exhibited any of the following symptoms: Fever, Chills, Repeated shaking with chills, Muscle pain, Headache, Sore throat, New loss of taste or smell, Congestion or runny nose, Shortness of breath or difficulty breathing, Fatigue, Nausea or vomiting, or Diarrhea?* This field is required.

My child does not exhibit any of these symptoms.

My child exhibits one of these symptoms.

My child exhibits two or more of these symptoms.

18

I will keep my child home if he or she feel ill or begin to exhibit symptoms between now and the scheduled service.* This field is required.

Yes, I agree

19

I understand that slots are limited and will notify the Children's Church Staff if my child cannot attend.* This field is required.

Yes, I understand and agree.

20

I understand that if my child's temperature is higher than 100.4, he or she will be asked to go home.* This field is required.Every attendee will undergo a temperature check with a touch-less thermometer, prior to admission.

Yes, I understand.

21

New Vision International Ministries is doing everything we can to be compliant with all regulations to ensure you and your family's safety. We have put in place preventative measures to reduce the spread of COVID-19, but we cannot guarantee that you or family members will not become infected with COVID-19.* This field is required.

I understand and agree that this release includes any claims based on the actions, omissions, or negligence of this organization, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any such program, service or activity.