MJE West Outdoor Friendsgiving Shabbat Dinner  Application + Health Form
Please fill out the following application and health form for MJE West's Outdoor Shabbat Dinner on November 13th 2020.

Where: New Amsterdam Burger Outdoor Seating

Social Distancing will be observed | Limited Seating | 20s & 30s

Early Bird tickets on sale till 11/6 $55
Regular tickets on sale till 11/10 $70
Late Tickets on sale till 11/12 $80

You may sign up as an individual or sign up in a group of 2 or 4. If you sign up as an individual without seating request, you agree to sit with 3 other YJPs, who will all be filling out a health form. Please request your group below.

*** This is not your ticket. You will receive a confirmation of your acceptance with a link to purchase tickets. ***

We will require a health form to be filled out closer to the date of the dinner. Thank you for your compliance and understanding!

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First Name *
Last Name *
Age *
Gender *
Phone number *
Email Address
Food allergies? *
Required
Seating request. Please list the people you wish to be seated with. You may sign up as an individual or sign up in a group of 2 or 4. If you sign up as an individual without seating request, you agree to sit with 3 other YJPs, who will all be filling out a health form. Please request your group below. *
How did you hear about this event? Which MJE Staff member invited you? *
Are you in the Cohort or Fellowship? *
What is your religious background? *
What high school did you attend? *
Have you knowingly been in close or proximate contact with anyone who has been tested positive for COVID-19 in the past 14 days? *
Have you tested positive for COVID-19 in the past 14 days? *
Have you experienced any symptoms of COVID-19 in the last 14 days including, but not limited to fever, cough, loss of smell or taste, sore throat, stomach issues or body ache? *
Have you been outside the US or to a state with a high incidence of Covid-19 in the past 14 days per the list of states issued by NY State? *
Please check off any symptoms you may have experienced in the last 14 days. *
Required
All participants must wear a face mask and remain 6 feet away from others. You may not attend if you have experienced 1 or more of the symptoms listed above in the last 2 weeks. MJE will provide sanitizer/wipes and ask participants to use as wanted In addition, staff will sanitize prayer books and other shared materials. Do you agree to uphold all social distancing and safety requirements explained above? *
Please be aware that by attending this event you agree to the following: I  am fully and personally responsible for my own safety and actions while and during may participation and I recognize that I may be in any case be at risk of contracting COVID-19. With full knowledge of the risks involved, I hereby release, waive, discharge MJE, its board, officers, independent contractors, affiliates, employees, representatives, successors, and assigns from any and all liabilities, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, injury, or death, that may be sustained by me related to COVID-19 while participating in any activity while in, on, or around the premises or while using the facilities that may lead to unintentional exposure or harm due to COVID-19. I agree to indemnify, defend, and hold harmless MJE from and against any and all costs, expenses, damages, lawsuits, and/or liabilities or claims arising whether directly or indirectly from or related to any and all claims made by or against any of the released party due to injury, loss, or death from or related to COVID-19.  Do you agree with these terms and conditions? *
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