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North Shore Mikvah Attendant's Log
Under the Auspices of Chabad North Shore
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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
*
Your answer
Contact Number
*
Your answer
Date and Time of Use
*
Please note: the time is 24hr time
MM
/
DD
/
YYYY
Time
:
AM
PM
Mikvah User 1
*
Your answer
Contact Number for User 1
Your answer
Mikvah User 2
Your answer
Contact Number for User 2
Your answer
Mikvah User 3
Your answer
Contact Number for User 3
Your answer
Mikvah User 4
Your answer
Contact Number for User 4
Your answer
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