JELC - Health Screening Form

Please complete the following information EACH day you enter Jehovah Evangelical Lutheran Church prior to entry. If you answer “Yes” to any of the screening questions, you are not allowed to enter the building. Please, stay home, stay away from other people, and contact you health care provider.

Do you have...

NOTE: This form is only valid for the date on which it is submitted. Do not submit the form on the previous day or earlier.