Please fill this out 2 – 4 hours prior to each event you plan to attend. If you are human, leave this field blank.Event Type *What type of event will you be attending?Staff / Office VisitSr. High EventMiddle School EventConfirmation Event (Whitlock/Rogers)Confirmation Event (Eichers)NameEmailPhoneQuestionsI understand that I must agree to and affirm the following statements for myself and anyone in my household to be present at any in-person event at BRPC *I agreeNeither myself or anyone in my household has traveled out of the immediate region (New York, Connecticut, Pennsylvania, and Delaware) within the past 14 days. *I agreeCurrent Symptoms *Neither myself or anyone in my household has had any of the following symptoms in the last 14 days: sore throat, cough, chills, body aches for unknown reasons, shortness of breath for unknown reasons, loss of smell, loss of taste, fever of 100.0 degrees or greaterI agreeSocial Distancing / Large Gatherings *In the last 14 days, neither myself or anyone in my household has been to a large gathering (indoor or outdoor) where social distancing was not feasibleI agreeNeither myself or anyone in my household is currently awaiting the results of a COVID-19 test *I agreeNeither myself or anyone in my household has tested positive for COVID-19 and have yet to be medically cleared *I agreeAcknowlegement of Risk *I agree to immediately let BRPC know if any of the information on this form changes. Given the current pandemic I understand that there are inherent risks associated with being present at the Basking Ridge Presbyterian Church and agree to assume all risks associated with it. I also agree to let the church know immediately if I am diagnosed with COVID-19 following this eventI agreeSubmit
