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Shabbat Registration Covid
Please verify reCaptcha before submitting the form.
This form is part of our beta-testing of our new CNT website. Please disregard any information not part of this form.
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First Name
*
Last Name
*
Email
Phone Number
*
I wish to attend Friday night services on:
Friday, April 23
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 100
Unusual Tiredness
New Onset of Cough
Aches & Pains
Sore Throat
Diarrhea
Loss of taste or smell
None 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)
Fri, April 19 2024 11 Nisan 5784