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CHRIST TEMPLE

APOSTOLIC CHURCH

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Covid-19 Health Declaration

How are you feeling today?

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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

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Date

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Saving the Lost. Equipping Disciples

2651 N. Hamline Avenue

Roseville, MN 55113

651-628-9090

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