High Holiday Registration Form for In -Person B'nai Israel Synagogue Services
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 *
Last Name, First Name *
Mobile Phone Number *
Are you fully vaccinated against Covid-19? *
Date of Final Covid-19 Vaccination *
If you or anyone in your household is in contact with someone with a confirmed COVID-19 infection in the 14 days prior to Yom Kippur, you agree not to attend in person activities. *
If you travel internationally in the 14 days prior to Yom Kippur, you agree to notify Bnai Israel Synagogue *
I plan to attend Kol Nidre services Erev Yom Kippur in person *
I plan to attend services Yom Kippur Day in person *
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. *
Name with Date *
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