2021 Weekly JOURNEY Youth Registration

We look forward to seeing you at JOURNEY Youth, Wednesday @ 6:15pm! Please provide the following information to complete your registration.

(Note: Upon approaching any outdoor space or building on the HV campus, you will be required to wear a facemask and remain socially distant. Enter Youth Area through the Building D entrance. If you are unable to enter, please call Matt Taylor at 501.772.5922)

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* 1. Your contact info:

First Name *

Last Name

Email Address *

Phone Number *

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* 2. How many will be attending in your group?

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* 3. Provide the full name of each indivdiual in your group.

Name

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* 4. Do any of the following apply to you? If you check any of them, please DO NOT ATTEND Journey Youth.

Have had a fever of 100.4 or greater in the last 2 days

Have a cough, difficulty breathing, sore throat, or loss of taste or smell

Have had close contact with person known to be infected with Covid-19 in the previous 14 days. (Please note: Close contact is defined as having been withing 6 ft of a Covid-19 positive patient for 15 minutes or more within 48 hours of testing positive.)

Other (please specify)

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* 5. How would you like to receive additional information and/or updates about Journey Youth?

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Both