Contact Tracing Form

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Seat No. ____________ Seat No.

____________

Date of Mass: ___/___/______ Time of Mass: _______ Date of Mass: ___/___/______ Time of Mass: _______

Name: ________________________________________ Name: ________________________________________

Address: _____________________________________ Address: _____________________________________

______________________________________________ ______________________________________________

Cellphone Number: ____________________________ Cellphone Number: ____________________________

Email Address: ________________________________ Email Address: ________________________________

All information you share on this form will be kept All information you share on this form will be kept
confidential and will only be used for contact tracing should confidential and will only be used for contact tracing should
the need arises. Thank you for your cooperation. the need arises. Thank you for your cooperation.

Seat No. ____________ Seat No. ____________

Date of Mass: ___/___/______ Time of Mass: _______ Date of Mass: ___/___/______ Time of Mass: _______

Name: ________________________________________ Name: ________________________________________

Address: _____________________________________ Address: _____________________________________

______________________________________________ ______________________________________________

Cellphone Number: ____________________________ Cellphone Number: ____________________________

Email Address: ________________________________ Email Address: ________________________________

All information you share on this form will be kept All information you share on this form will be kept
confidential and will only be used for contact tracing should confidential and will only be used for contact tracing should
the need arises. Thank you for your cooperation. the need arises. Thank you for your cooperation.

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