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Yonkers SDA Church

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Please pre-register to reserve your time and to help us keep an accurate log. Once you submit the form you may attend unless you are told otherwise.

CHOOSE A TIME TO JOIN US Sabbath School on Saturday 9:30am - 10:45am Church Service on Saturday 11am - 1pm Other

Name

Names of Additional People in your group

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

Please consider answering the following questionnaire. You are not required to answer these questions unless you are part of the staff. However, if you cannot answer "No" to the following questions than please stay home and respect the safety of others.

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.

793 N Broadway, Yonkers, NY 10701

Yonkers SDA Church | 793 N Broadway | Yonkers, NY 10701-1206 | 914-999-2963

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Yonkers SDA Church

Please pre-register to reserve your time and to help us keep an accurate log. Once you submit the form you may attend unless you are told otherwise.

​Please consider answering the following questionnaire. You are not required to answer these questions unless you are part of the staff. However, if you cannot answer "No" to the following questions than please stay home and respect the safety of others.

*​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.

Please consider answering the following questionnaire. You are not required to answer these questions unless you are part of the staff. However, if you cannot answer "No" to the following questions than please stay home and respect the safety of others.

*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.