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Selichot Service 2021 - 5781 Sign-up Form
*Until further notice you must fill out the registration form below in order to attend.
*Masks are required inside our building
*A confirmation email and/or phone call will be sent to you.
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Email
*
Your email
Name
*
Your answer
Phone number
*
Your answer
Spouse (or family member/s)
*
Your answer
Covid-19 Health Questions
Please answer the following questions.
It has been 10 -14 days since I received the final vaccination of:
*
Pfizer/Moderna
Johnson & Johnson
Note: Please answer "yes" to the relevant questions below if it applies to you, your spouse, or family member that will be attending.
Do you commit to check your temperature before coming to services and to stay home if it is 100 degrees or above?
*
Yes
No
Do you agree to stay home if you have any of the following conditions: coughing, fever, chills, loss of smell, rash on the bottoms of the feet, or ANY suspicion that you may be ill or have been exposed to someone else who is ill?
*
Yes
No
By filling out this form you are agreeing to notify Rabbi Singer if you discover you are exposed or test positive for Covid-19 after attending services.
*
I Agree
Required
A copy of your responses will be emailed to the address you provided.
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