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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!
Do NOT sign up if you can’t “agree” or say “yes” to ALL the questions below in the sign up.
**Those over the age of 65 or in a high-risk group (ie, chronic lung disease or moderate to severe asthma, serious heart conditions, immunocompromised, severe obesity, diabetes, chronic kidney disease undergoing dialysis, liver disease, etc) should consult with their physician before signing up.**
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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
Do you agree to wear a face mask at all times while you are at PHS and wash/sanitize your hands or put on fresh gloves when you arrive?
*
I Agree
Required
Do you agree to keep at least 6 feet away from anyone in attendance?
I Agree
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
Required
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
Required
I wish to attend the following minyanim this week:
*
7/9 Shivah Asar b'Tammuz Mincha/Maariv (8:00pm)
7/11 Shabbat Mincha (7:30pm)
Required
If you've any additional related information please share:
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