Jerusalem MB Church Registration

Jerusalem MB Church Sunday Service Registration

We welcome you back to spiritually enlightening and engaging corporate worship!! And we would like to make your participation as physically safe as possible. Please take a moment to provide the information below:

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* 1. Date

Date / Time

Date

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* 2. Name

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* 3. Please share your Vaccine Status (Select ONE choice only)

I am Fully Vaccinated ( two Pfizer or Moderna vaccines OR 1 Johnson& Johnson vaccine (at least two weeks ago)

I am Fully Vaccinated and with booster (at least two weeks ago)

I am Partially Vaccinated ( one Moderna or Pfizer vaccine)

I am NOT Vaccinated at this time

I would like more information about the vaccines

Other (please specify)

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* 4. Please share your plans for attending service during the next month

I plan to attend in-person services in the Jerusalem MB Church sanctuary

I plan to attend Virtual/On-line service

I plan to attend in-person and on-line service

I am undecided

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* 5. If you are planning to attend in person, how many are in your family group?

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* 6. Contact Information (Optional)

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number