ADSF

Informed Consent

Archdiocese of San Francisco: Informed Consent Form

Archbishop Salvatore Cordileone in keeping with the compliance protocols (issued by the County and City Health Departments),  urges  us to comply with those directions.  He asks us to  read, complete and sign up acknowleding this "Informed Consent Form". 

This consent Form is designed  to help establish 'contact tracing' if that becomes necessary in the future. 

You are urged to download this Form from the Parish website, print a copy, sign it and drop it in the collection basket.

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Informed Consent for In-Person Attendance at Mass

During COVID-19 Public Health Crisis

St. John the Evangelist parish intends as best it can to follow all mandated Archdiocesan safety protocols and county regulations for public worship services. However, the county medical officer has advised us that public gatherings may nevertheless present an increased possibility of contagion even if safety precautions are taken, and therefore he has asked us to inform you that your participation may increase the risk for yourself and your family.

In particular, if you are over the age of 50 or have a chronic or underlying medical condition, a gathering increases your risk of contracting the virus or if you do contract the virus it may have a greater chance of creating serious illness that could even result in death. If you fall into this high-risk category and/or if you feel sick, are displaying COVID-19 symptoms (especially fever, cough or difficulty breathing) or if any of these symptoms are being experienced by someone in your household, you should stay home. The church cannot guarantee that there is no risk of infection for attendees.

Your signature below indicates that you understand these risks and agree to abide by all safety protocols and to follow all other instructions that may be given, and that you acknowledge the risks involved. This information will be kept confidential to the extent the law allows, and is protected from law enforcement and immigration authorities.

Name: _________________________________________________________

Address: _______________________________________________________

and/or

E-mail address: __________________________________________________

Names of Family Members Attending: _______________________________

Please download and print out this Form, sign it and drop it in the collection basket.

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