Pre-screening Questionnaire
Pre-authorization is required for attendance at all in-person worship services.  Though you may receive the initial clearance, on-site screening and a temperature check are still required.  To help us prevent and slow the spread of COVID-19, please answer all questions as truthfully as possible.
Have you had contact with someone who was diagnosed with COVID-19 (within the past 2 weeks)?

Within the last 2 weeks, have you experienced any of the following?

Abdomoinal Pain?
Bruising or bleeding?
Chills?
Conjunctivis?
Cough greater than 3 weeks?
Cough with blood?
Diarrhea?
Fever?
Headache?
Joint pain?
Muscle pain?
New loss of taste or smell?
Night sweats?
Rash?
Repeated shaking with chills?
Severe headache?
Shortness of breadth?
Sore Throat?
Unintentional Weight Loss?
Vomiting?
Weakness?
Will other individuals accompany you to this service?

If a visiting adult will accompany you to this church service or event, please direct them to the Ignite website for pre-authorization (if possible). 

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102 North St NW Leesburg, VA 20176 | info@igniteloudoun.com | Tel: 703 651 - BURN