Emergency Management

Place of Worship Masks Request Form

Is your organization having an in-person Holiday Service?

Yes

If yes, please list # of holiday Services:

Place of Worship Name:

Place of Worship Address:

Contact Name for Place of Worship:

Phone Number for Contact Person:
provide a monitored number in case we have questions about your request.

Average Weekly In-Person Attendance:

Approximate Number of Masks Needed:

Monitored Email Address:
This is how we will communicate request status and updates.

Please list any additional information that should be considered for your request.

Once this request has been reviewed, an email will be sent to the monitored email address provided above notifying of the status of your request. If your request is approved this email will also include pick-up instructions.

Acknowledge