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Harlem Ministry Wellness Form
If you are planning on attending as a household/family, only one form needs to be submitted. Simply fill out the additional attendees and their information where applicable and attest for the group together. The welcome message you will receive after filling out the form will be the entrance for your group collectively.
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When you have completed the form, please take a screen shot of your "welcome" page to show to the ushers when you enter. Thank you
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Untitled checkboxes field
I attest that the following statement is true: "I (or anyone else represented in this form) am not currently testing positive for COVID-19, have not been in close contact with someone who has symptoms of or tested positive for COVID-19 in the last 5 days (except in the case that I am a healthcare worker in which I attest that I wore the proper personal protective equipment and took all necessary precautions), have not traveled outside of the United States, and do not have any of the following symptoms: fever or chills, cough, shortness of breath or difficulty breathing, tiredness, muscle or body aches, headaches, new loss of taste or smell, sore throat, congestion or a runny nose, nausea or vomiting, or diarrhea.
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Submit
