Registration for Shaare Tefila services
By filling out this form you are affirming that you are fully vaccinated (i.e. you are at least 2 weeks beyond your final vaccination) and that you are exhibiting NO symptoms.
登入 Google 即可儲存進度。瞭解詳情
電子郵件 *
Last name *
First name *
email address *
cell phone number *
Have you been fully vaccinated (i.e. has it been at least two weeks since your second Pfizer or Moderna shot was administered or two seeks since your Johnson & Johnson shot was administered)? *
How many will attend with you? What are their names?  Please note that everyone over the age of 12 must be fully vaccinated - as defined above. Younger children must wear a mask. *
Have you or anyone in your household experienced any of the following symptoms in the past 48 hours: fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea? *
Within the past 14 days, have you, or anyone in your household, had close contact (within 6 feet for 15 minutes or more) with someone with suspected or confirmed COVID-19? *
Have you or anyone in your household tested positive for COVID-19 in the last 10 days, or waiting for the results of a COVID-19 test? *
I have read and I agree with the policy above and I have answered these questions truthfully. *
提交
清除表單
請勿利用 Google 表單送出密碼。
這份表單是在 Shaare Tefila Congregation 中建立。 檢舉濫用情形
Google 表單