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FBF - COVID19 CHECK IN FORM - Sunday January 25, 2026

The coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. As a result, federal, state and local governments and agencies recommend social distancing and have, in some locations, prohibited the congregation of groups of people. By attending worship services, participating in programs and activities of FBF Ministries, you agree to adhere to all safety measures put in place to ensure a safe time of worship, programs and activities while in the building. This includes but is not limited to: wearing a face covering at all times, following seating instructions, following traffic flow, washing/sanitizing hands and limiting walking and answering ALL questions on this form.

COVID-19 CHECK IN FORM

First Name Last Name Telephone Email Address

1) Have you been fully vaccinated? Has it been two weeks after the second vaccination shot. (It is required that one is fully vaccinated for access to the service)

Yes
No

2) Have you had close contact (within 6 feet for at least 15 minutes) in the last 14 days with someone diagnosed with COVID-19 OR has the Health Department or a health care provider advised you to quarantine?

Yes
No

3) Have you had fever, chills, shortness of breath/difficulty breathing, new cough, loss of taste or smell in the past 48 hours?

Yes
No

4) Are you currently waiting on the results of a COVID-19 test?

Yes
No

5) Have you traveled to a COVID-19 hotspot in the last 14 days?

Yes
No

6) Have you traveled out of the country in the last 14 days?

Yes
No

Question 1) MUST be Yes and Questions 2 - 6 must be "NO" to have approved Access to facility. "Otherwise Regretfully, access to facility NOT APPROVED.

Protective measures have been put in place to reduce the spread of COVID-19; however, we cannot guarantee that you or your family members will not become infected with COVID-19. On behalf of yourself and your children, you hereby release, covenant not to sue, discharge and hold harmless FBF Ministries, its employees, agents, representatives, subsidiaries/affiliates of all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating to your participation in our program, services or activities. You understand and agree that this release includes any claims based on the actions, omissions or negligence of this organization, its employees, agents, representatives, subsidiaries/affiliates, whether a COVID-19 infection occurs before, during or after participation in any such program, service or activity.

Completion and submission of the FBF Ministries COVID-19 Check-In Form is required for each person to attend worship services and activities at FBF Ministries (no exceptions). Submission of this information DOES NOT confirm nor reserve seating.

Check-In confirmation must be presented upon arrival at FBF Ministries. Thank you, we look forward to worshipping with you!

Sign and Date

Signature Date