North Shore Mikvah Attendant's Log
Under the Auspices of Chabad North Shore
We understand that we are in unique times. Please fill out this form so that we can safely track users and attendants of the Mikvah in case of emergency.
Mikvah Attendant's Name *
Contact Number *
Date and Time of Use *
Please note: the time is 24hr time
MM
/
DD
/
YYYY
Time
:
Mikvah User 1 *
Contact Number for User 1
Mikvah User 2
Contact Number for User 2
Mikvah User 3
Contact Number for User 3
Mikvah User 4
Contact Number for User 4
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy