Services Covid 19 Questionnaire

* Email

* First

* Last

* Phone

Number of People

Friday, June 18 - 47 of 50 Left

Saturday, June 19 - 48 of 50 Left

You must answer the following questions prior to submission. You are also required to ask the people in your party and answer accordingly.

* Have you, or anyone attending with you, had COVID-19 symptoms in the past 10 days? (Fever greater than 100.4 degrees, cough, shortness of breath, difficulty breathing, chills, muscle pain, headache, sore throat, loss of taste or smell)

YesNo

* Have you, or anyone attending with you, tested positive for COVID-19 in the past 10 days.

YesNo

* Have you or anyone attending with you, been in close contact with a confirmed or suspected COVID-19 case in the past 10 days?

YesNo

* Have you or anyone in your household traveled out of New York to a COVID State hotspot in the past 10 days? Please click on the link below for the restricted states

YesNohttps://coronavirus.health.ny.gov/covid-19-travel-advisory

If you answered "yes" to any of the questions or have any of these symptoms please do not attend services or come to the synagogue.

If you develop any of these symptoms or test positive after the time you registered to attend services, please do not attend services or come to the synagogue.

By attending services and events at the Congregations facilities, all members, their family members and guests acknowledge that there is a risk of exposure to COVID-19 and any and all consequences thereof.

Please make responsible informed choices about attending services and events.

I hereby represent to Congregation Beth Ohr and all other people in attendance at the services that I have answered the questions truthfully and accurately. I represent that I have personally asked the aforesaid questions of each person attending with me and have answered accordingly.

* I Agree

I Agree

Sat, April 26 2025 28 Nisan 5785

2550 South Centre Avenue

Bellmore, NY 11710

(516) 781-3072

Affiliated with United Synagogue of Conservative Judaism

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