Screening Questionnaire / Booking Form for Members and Visitors

The health and well-being of our congregation, visitors, employees, and communities remain our primary priority and as such we are now requiring all visitors to provide responses to the below questions prior to being permitted entry into our facilities. We apologise for any inconvenience caused.

Please take note that due to the new regulations announced by President Ramaphosa, 250 people can attend a service.
NB : one person can only register for one service on a Sunday. If you would like to attend another service, please put your name on the waiting list.

 

Please Note
If you have completed this form before, please fill in your cellphone number to call up your information.

Cellphone Number  
  

 

Current Bookings:
11 Apr 08h30
10h30
18h30		 139
51
52
18 Apr 08h30
10h30
18h30		 32
12
23
25 Apr 08h30
10h30
18h30		 23
3
19
02 May 08h30
10h30
18h30		 7
0
5
Bybelskool:
 13 Apr		   7

 

Name * Surname *
ID Number * Cell Number *
Address *    
Which service will you be attending? *
08h30   10h30   18h30  

Bybelskool

 Date of Service: * Format: YYYY-MM-DD
1. Do you experience any of the following flu-like symptoms:

* fever
* cough / scratchy throat
* loss of smell / taste
* trouble breathing / shortness of breath		 Yes     No
2. Do you have heart, lung, kidney disease or diabetes? Yes     No
3. Have you been in contact with a confirmed Covid-19 person? Yes     No
4. Have you traveled in the past 14 days to a Covid-19 region? Yes     No
I hereby agree that the church assumes no liability / responsibility for any harm or illness as a result of visiting the church property. I declare that the information provided above is accurate.
Date *:
* denotes a required field