Wednesday Well In-Person Registration

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Hi! Please fill out this form if you would like to attend NMPC's Wednesday Well prayer meeting.

COVID-19 is still a reality, and we want to take appropriate safety precautions to keep our members as safe as possible. This registration will screen for risk factors (e.g., exposures) and symptoms.

Please note the following:
1) ATTENDANCE
---> Capped at 14. Socially distanced, this is the maximum number of people we can allow in the space.

2) MASKS
---> Wearing a mask is required at all times.

3) SANITIZER
---> Hand sanitizer we be available upon entrance.

4) TEMPERATURE CHECK
---> Temperature will be checked using a touchless device prior to entrance. (99.5 degrees or higher will be asked to return to the car/home to participate via Zoom.)

5) VENTILATION
---> Windows will remain open for ventilation.

6) STREAMING
---> The prayer meeting will be live streamed via Zoom at nmpc.live/zoom.

7) RISK
---> Because we will be in a smaller, enclosed space (albeit with ventilation), please be aware that there is still some risk. We will take these very effective safety precautions, but risk is never completely eliminated.

Email Address *

Within the past two months, have you tested positive for COVID-19? *

YES

In the past 14 days, has a family member/co-worker (that you routinely see) tested positive for COVID-19? *

YES

Within the past 24 hours, has your body temperature been 99.5 or higher? *

YES

Have you experienced any of the following symptoms in the last 14 days? (check all that apply) *

Shortness of breath/difficulty in breathing

Cough

Runny nose

Sudden loss of taste/smell

None of the above

Required

In the past 7 days, have you or a proximate family member travelled outside of the immediate region (outside of NJ, NY, CT, PA or DE)? *

YES

I agree to: Wear a mask on my face at all times; Have my temperature checked before entering the building; Sanitize my hands upon entry (hand sanitizers will be provided at check-in); Maintain 6 feet of distance with people; Sit at designated marked areas. * *

I agree

I disagree

I also agree to stay at home, if since registering, I experience any of the above symptoms or if I believe that I have been exposed to someone who has COVID-19. *

I agree

I disagree

Please sign your full name below to indicate your understanding and adherence to expectations and protocols for in-person attendance at Wednesday Well. *

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