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PHS Minyan Registration Form
Attendance will be confirmed by Rabbi Leener or a Board member ONLY. Please do NOT just show up. Thank you!
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* Indicates required question
Name
*
Your answer
Email
*
Your answer
Cell Phone # (**We will be using a WhatsApp group for live updates and announcements**)
*
Your answer
Can you confirm that you have not experienced any of the COVID-19 symptoms (Fever > 100, Chills, Muscle pain, Cough, Shortness of breath, Headache, Sore throat, Runny nose, Diarrhea, Vomiting, New loss of taste or smell) in the past 14 days?
*
Yes
Can you confirm that to the best of your knowledge you have not come in close contact or cared for someone diagnosed with or suspected to have COVIOD-19 within the past 14 days?
*
Yes and I'm fully vaccinated
Yes
No - but I tested negative after contact.
No
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