pre-Yom Tov visits to the Sanctuary - Form - Hebrew Institute of Riverdale

* 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 household has been exposed to someone with a positive lab test for Covid-19 in the past 14 days.

2) No one in our household 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 anyone in our household develops symptoms or find out they have been exposed to someone with Covid-19 I will let the Bayit office know as soon as possible and will cancel our reservation for the Sanctuary.

Do you agree to wear a face mask covering the mouth and nose while you are indoors at the Bayit and wash/sanitize your hands or put on fresh gloves when you arrive?

NoYes

I understand that attending any prayer service, class or other program at the Bayit or using the facilities of the synagogue 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.

* First Name

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* Last Name

* Cell Phone Number

By filling out this form you agree to provide your cell phone number and join the WhatsApp group "Bayit Playground Users".

* Email Address

If no remaining slots work for you, please enter your preferred times below to help us understand desired usage and adjust the number of slots we make available per family.