Tween & Teen Tikkun Leil Shavuot

* Please confirm that you are in good health and will let us know if something changes:

NoYes1) At this time and to the best of my knowledge, no one in our family has been exposed to someone with a positive lab test for Covid-19 in the past 14 days.

2) No one in our family currently has a fever over 100 degrees or unexplained symptoms such as loss of taste or smell, difficulty breathing, coughing, headaches or gastrointestinal difficulties.

3) If any of us develop symptoms or find out we have been exposed to someone with Covid-19 I will let the Bayit office know as soon as possible and will not attend programs at the Bayit.

Do you agree to wear a face mask at all times while you are at the Bayit and sanitize your hands or when you arrive?

NoYesChildren 3 and up will be required to wear a face mask.

I understand that attending any prayer service, class or other program at the Bayit is my choice. I therefore release Hebrew Institute of University Heights, dba Hebrew Institute of Riverdale from any and all liability for any unintentional exposure to viral or bacterial infection.

Parent's First Name

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Parent's Last Name

* Cell Phone Number

* Email Address

Name of Child

Please fill out a separate form for each child.

Name(s) of Parents joining their child at the program (where applicable)

Which program or programs will your child attend: (select all that apply)

I would like to contribute $____ to support quality Youth Programming

TWEENS (Grades 5-8)*

TEENS (Grades 8-12)*