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This form is part of our beta-testing of our new CNT website. Please disregard any information not part of this form.

* First Name

* Last Name

* Email

Phone Number

* I wish to attend Friday night services on:

Friday, May 21

Total number of people attending

* If I had any of these symptoms, I attest (both are required for entry):

I have quarantined for at least 10 days from the start of symptoms.It has been at least 3 days since the symptoms completely resolved.Not Applicable

* Have you had any of the following symptoms (check all that apply):

Fever above 100Unusual TirednessNew Onset of CoughAches & PainsSore ThroatDiarrheaLoss of taste or smellNone of the above

* I attest that I have NOT had direct contact with anyone known COVID-19 unless I was appropriately using personal protective equipment (PPE).

I attest that I have NOT had direct contact with anyone known COVID-19 unless I was appropriately using personal protective equipment (PPE).

* * I have NOT tested POSITIVE to any COVID-19 test within the past 10 days.

* I have NOT tested POSITIVE to any COVID-19 test within the past 10 days.

* * I understand that by reserving a space that I am agreeing to follow the guidelines and restrictions that Congregation Ner Tamid's Covid-19 Task Force is requiring.

* I understand that by reserving a space that I am agreeing to follow the guidelines and restrictions that Congregation Ner Tamid's Covid-19 Task Force is requiring.

Notes (seating choices for example)

Wed, April 24 2024 16 Nisan 5784

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