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COVID-19 Self-Declaration of Health Form

For the health and safety of our community, a self-declaration of health form is required of all non-vaccinated attendees for each service they sign up for.

If you do not timely submit a signed form you will not be permitted inside the Shul.

***One form must be completed for every non-vaccinated person attending each service.***


By clicking submit below, I acknowledge that the information I have given is accurate and complete.
Sat, January 22 2022 20 Shevat 5782