Religious Exemption for the Coronavirus Vaccine

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Address

What industry do you work in?

What church do you attend?

Are you a born again Christian who believes in the validity of Scripture?

Terms

By receiving the religious exemption form, certified by Pastor Greg Simas of Convergence Church, I agree and understand the following:
(1) I understand that the exemption form v.2021 is not a legal document
(2) I understand that the exemption form v.2021 does not serve as legal advice
(3) I release Greg Simas, Convergence Church, and all of its associates of any liability and damages as a result of the religious exemption form v.2021
(4) I have read and affirmed the beliefs in the religious exemption form v.2021
(5) I verify that I am a practicing Evangelical that adheres to the religious and moral principles outlined in the Holy Bible.
(6) I affirm that I have attended a service at Convergence Church
(7) I understand I cannot distribute the religious exemption form v.2021 without the written consent of Convergence Church
(8) I agree not to distribute or share this exemption, nor use it or submit it in any news reporting

I, the undersigned, agree to the terms above.

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RELIGIOUS EXEMPTION