Reservation form for In -Person B'nai Israel Synagogue Events
Anyone attending a synagogue event  must complete the following questionnaire, sign it and send it back two days prior to the event.  EACH PERSON ATTENDING MUST FILL OUT THEIR OWN FORM. In order to attend an event, all questions below must have a response.
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Email *
Full Name *
Mobile Phone Number *
Are you fully vaccinated against Covid-19? *
Required
Date of Final Covid-19 Vaccination *
MM
/
DD
/
YYYY
Are you under age 12? *
Required
If you are experiencing any symptoms of Covid 19 you agree not to attend in person activities *
Required
Have you or anyone in your household been in contact with anyone in the past 14 days with a confirmed COVID-19 infection? *
Have you traveled Internationally in the last 14 days? *
If you have traveled internationally, please indicate name of country. *
By checking the box below, I am in effect signing this agreement and thereby acknowledge the contagious nature of COVID-19, and voluntarily assume the risk that I may be exposed to or be infected by COVID-19 by my mere presence at an event either inside or outside the building, and that such exposure or infection may result in injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 may result from the actions, omissions, or negligence of myself or others including but not limited to employees, volunteers, congregants, program participants and vendors. I hereby release B'nai Israel/Temple Kol Ami  from any and all claims arising from or in connection with any direct COVID-19 impact. *
Required
Name with Date *
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