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Divine Glory Ministries, Inc.

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Covid Check - In

Covid-19 Health Declaration

How are you feeling today?

First Name

Last Name

Do you practice wearing a mask at all times in public places?

Do you wear a mask while socially engaging with others?

My body temperature is lower than 98.6°F/ 37.5°C

I am not experiencing headache (consistent or not), flu, sinus or allergy like symptoms.

I haven’t been in close contact with a Covid-19 patient in the last 14 days

Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting! Enjoy your time in worship.

COMPLETING A COVID WAIVER

537 A Silver Slipper Lane Tallahassee FL, 32303

P.O. Box 37153 Tallahassee, FL 32315

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