Kehilat Haverim Mashiach

Please Fill Out The Form Below

Covid19 Waiver Form

In order to protect each other as we come together to worship. We require each person who enters our area for worship to sign this waiver.
To be filled out by each person wanting to enter the service. This is in order to comply with government and health official regulations to track who has come into our facility in case there is a need to verify those who fall ill due to COVID-19. We will NOT share this information with anyone outside the congregation unless required to do so to comply with health officials to deal with any COVID-19 issues.
  • First Name
    Last Name
  • I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the government and many other public health authorities still recommend practicing physical distancing. I further acknowledge that Kehillat Haverim Mashiach/Friends of Messiah Congregation has put in place preventive measures to reduce the spread of the Coronavirus/COVID-19. I further acknowledge that Friends of Messiah Congregation cannot guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, congregation leaders, and other worshippers and their families. I voluntarily come to worship the Lord at Friends of Messiah Congregation wherever they meet and acknowledge that by doing so I may be increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending congregational services and other events.
  • I attest that: I am not experiencing any symptoms of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.
  • I attest that: I have not travelled internationally within the last 14 days.
  • I attest that: I have not travelled to a highly impacted area within Canada or the United States of America in the last 14 days.
  • I attest that: I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.
  • I attest that: I have not been diagnosed with Coronavirus/Covid-19 and have yet cleared as non-contagious by public health authorities.
  • I attest that: I am following all recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19. I hereby release and agree to hold Friends of Messiah Congregation/Chosen People Ministries (Canada) harmless from, and waive on behalf of myself, my heirs, and any personal representatives, any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the congregation, or that may otherwise arise in any way in connection with any services held at Friends of Messiah Congregation.
  • Signed in person. Please list any minors who will be joining you.