B.mitzvah Registration

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We are looking forward to seeing you at Shir Ami for a B.mitzvah service. In order to protect all participants, masks are required to be worn inside Shir Ami regardless of vaccination status. Please complete this registration form prior to attending.
Thank you!

* Date of B.mitzvah Attending:

* B.mitzvah Child's Name:

Your Name:

Email:

Phone Number:

* Total number attending (including yourself):

* Names of attendees:

* By checking this box and submitting this form, I agree......

By checking this box and submitting this form, I agree......1) In the past 10 days, I (we) have not tested positive for COVID-19 and are not awaiting test results.
2) I (we) have not been exposed without wearing the proper PPE to someone testing positive for COVID-19, is awaiting test results, or experienced COVID-19 symptoms, in the past 14 days.
3) If I or a guest has traveled internationally, we are vaccinated by an FDA authorized vaccine and have either a negative COVID-19 test 3-5 days, or have quarantined for 10 days prior to the B.mitzvah service. If we are unvaccinated, we have quarantined for 10 days prior and had a negative COVID-19 test 3-5 days prior to the B.mitzvah.
4) I will contact Phil Nordlinger if I or someone in my house tests positive for COVID-19 within 10 days from the completion of the service.

Tue, May 24 2022 23 Iyar 5782