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Covid-19 Health Declaration

How are you feeling today?

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Last Name

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My body temperature is lower than 100.0°F

I am not experiencing the symptoms: fever, cough, sore throat

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

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

I agree to the terms & conditionsView terms of use

Date

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MISSION STATEMENT

Saving the Lost. Equipping Disciples

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2651 N. Hamline Avenue

Roseville, MN 55113

651-628-9090

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