AWC COVID-19 Health Screening and Service Registration Form

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Alpha Worship Center | Bear, DE 19701 | Senior Pastor- Rev. Dr. Chad T. Hinson Sr

All members and non- members utilizing Alpha Worship Center facilities must self-monitor for COVID-19 by completing this quick and easy questionnaire each week. Based on your responses, you will receive a confirmation email from AWC staff and leadership indicating you are cleared to enter the facility. Please be mindful space is limited and each week the registration will be on first come first serve basis.

Individuals who will be attending our live worship service are required to: properly wear a face mask, adhere to the 6 feet of distance rule, hand sanitize as frequently as possible, and consent to a thermal temperature scan upon entering the establishment.

Email *

Sunday Church Service dates *

YYYY

First Name *

Last Name *

Contact Phone number *

Are you a AWC Member ? *

Yes

Have you been vaccinated or do you plan to be ? *

Yes

Have you been in close contact, or cared for someone with COVID-19 (e.g., within 6 ft for more than a few minutes) with a person with a confirmed COVID-19 infection ?) *

Yes

Do have body temperature of higher than 100.4°F or higher ? *

Yes

Have you experienced the following symptoms : Fever, cough , soreness of throat, or shortness of breath ? *

Yes

By signing my name below I hereby certify that my responses and other information provided in this document are correct *

A copy of your responses will be emailed to the address you provided.

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