High Holidays with Chabad of Chesterfield at Hilton Garden Inn RSVP form

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We're so glad you'd like to join us for High Holiday Services at the Hilton Garden Inn on Friday evening 7pm, Shabbat day 10:30am and 7pm, Sunday at 10:30am (September 18, 19 & 20, 2020)

For the full High Holiday Services Schedule at the Hilton Garden Inn, including an outdoor family seating patio option visit: chabadofchesterfield.com/3031782

To RSVP for the Shofar Service in Chesterfield's Central Park at the Amphitheater on Sunday, September 20, 2020 at 4:30pm at 16365 Lydia Hill Dr, Chesterfield, MO 63017 visit bit.ly/shofarcentralpark

In an effort to ensure everyone's safety, and so we can anticipate and prepare for the adequate amount of people, please submit your names and info using this form. In an effort to reduce the risk of COVID-19 exposure to the community, all visitors are asked to complete the screening questions now and will just be asked to confirm there have been no changes upon arrival to services.

Full Name *

Email *

Mailing Address (including zip code) *

Cell phone number

How many will attend in your party?

Has anyone in your party had close contact with or cared for someone diagnosed with COVID-19 within the last 14 days? *

Yes

Are you experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell? *

Yes

COVID-19 Liability Waiver

I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing.
I further acknowledge that Chabad of Chesterfield, Inc. has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.
I further acknowledge that Chabad of Chesterfield, Inc. can not guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to congregants and their families.
I voluntarily seek services provided by Chabad of Chesterfield, Inc. and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment.
I attest that:
* I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.
* I have not traveled internationally within the last 14 days.
* I have not traveled to a highly impacted area within the United States of America in the last 14 days.
* I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.
* I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by state or local public health authorities.
* I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.
I hereby release and agree to hold Chabad of Chesterfield, Inc. harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of Chabad, or that may otherwise arise in any way in connection with any services received from Chabad of Chesterfield, Inc. I understand that this release discharges Chabad of Chesterfield, Inc. from any liability or claim that I, my heirs, or any personal representatives may have against Chabad of Chesterfield, Inc. with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Chabad of Chesterfield, Inc. This liability waiver and release extends to Chabad together with all staff, board members, and volunteers.

I have read and agree to the COVID-19 Liability Waiver above *

Yes

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