Tefillah Signup: December 20 - 25 - 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 I have not been exposed to someone with a positive lab test for Covid-19 in the past 14 days.

2) I do not currently have a fever over 100 degrees or unexplained symptoms such as loss of taste or smell, difficulty breathing, coughing, headaches or gastrointestinal difficulties.

3) In the past 14 days I have not traveled outside the United States or to any state for which the State of New York requires a quarantine upon return.

4) If I develop symptoms or find out I have been exposed to someone with Covid-19 I will let the Bayit office know as soon as possible and will not attend tefillah at the Bayit.

Do you agree to wear a face mask at all times while you are 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 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

If your name has NOT been prefilled in this space, we appreciate your taking a moment to log in to your account using the box in the upper right hand corner of the screen.
Logging in saves you time - with prefilled answers on the form and saves us time - by not having to manually link your response to your account.
Thank you.

* Last Name

* Cell Phone Number

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

* Email Address

Are you reserving a seat in the Men's Section or the Women's Section?

Please ChooseMen's SectionWomen's Section

Which day or days do you want to join Tefillah (Men)

Please ensure that you are able to attend each tefillah that you reserve.

Which day or days do you want to join Tefillah (Women)

Please ensure that you are able to attend each tefillah that you reserve.

I was not able to sign up for tefillah on the day/time I wanted. Please put me on the waiting list if someone cancels.

Let us know which day or days you are available as a backup.

Please select one of the following:

I am not saying KaddishI am an aveil still in shloshimI am an aveil saying Kaddish for a parentI have yahrzeit this weekI am saying Kaddish for a relative or friend other than a parentAttendance will not be limited to those who are saying Kaddish. However, in this time when we are severely limiting the number of people at tefillah, we do wish to extend preference to those with a chiyuv while being open to giving everyone who wishes to participate in tefillah b'tzibbur the opportunity.

Please tell us when you have yahrzeit and for whom?