Sign In
Forgot Password
or Sign In With
Powered By
ShulCloud
Login
Home
Donate
OZ Website
Donate
Forms
High Holy Day Guest Tickets
Lulav & Etrog Order Form
Kiddush in the Round - Sukkot
Sukkot Dinner - October 3
Or L'Atid Pizza in the Hut
Sushi in the Sukkah
T'shuvah Lecture Resevations
Memorial Plaque Order Form
Membership Application
Renew My Membership
Home
Donate
Member Vaccination Status
Please verify reCaptcha before submitting the form.
At this time, everyone entering must be fully vaccinated. Please complete a separate form for each person and include the date each person was fully vaccinated.
*
First Name
*
Last Name
*
Email address
*
Cell Phone number
Please complete a separate form for each person attending and include the date each person was fully vaccinated.
*
Are you fully vaccinated?
Please Select One
Yes
No
*
Date of your final vaccination
*
Have you received a booster?
Please Select One
Yes
No
Date of your booster
*
Do you have any signs of COVID-19 or have you been exposed to anyone with a confirmed case of COVID-19 in the last 10 days?
Please Select One
Yes
No
*
Do you agree to notify Or Zarua if you become symptomatic or test positive for COVID within 5 days after attending services or any other event at Or Zarua?
Please Select One
Yes
No
By registering to attend, you acknowledge the significant risks associated with COVID-19 and that Or Zarua is making diligent efforts and taking reasonable precautions to mitigate those risks within its building. You understand that, despite its diligent efforts, Or Zarua cannot guarantee the health of anyone attending services or programs in its building.
Fri, September 22 2023 7 Tishrei 5784