Member Vaccination Status

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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?

* Date of your final vaccination

* Have you received a booster?

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?

* 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?

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.

Tue, February 7 2023 16 Shevat 5783