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Covid-19 Questionnaire

If you answer YES to the above question, please enjoy our on-line programming for 10-days.
Symptoms of illness include (in the past 48 hours) any of the following:  fever or chills, cough, shortness of breath or difficult breating, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, chest or nasal congestion, nausea or comiting, or diarrhea.
If you answer YES to the above question, please enjoy our on-line programming for 10-days.
Exposure means that you or someone in your household has been within 6 feet (for a period of 15 minutes or longer) of anyone who has been diagnosed with COVID-19, had direct physical contact (hugged or kissed) with someone who has COVID-19, or shared eating or drinking Utensils with someone who has COVID-19.
If you answer YES to the above question, please provide
a negative COVID-19 test result 3-5 days after exposure.
COVID-19 is very contagious and is believed to spread mainly from person-to-person contact.  Congregation Beth Emeth ("CBE") has put in place preventative measures to reduce the spread of COVID-19; however, CBE cannot guarantee that you will not become infected with COVID-19.  Further, participation in activities at (or provided through) CBE or your presence at its facilities could increase your risk of contracting COVID-19.  By signing this document, I acknowledge and agree to assume all liability as a result of my participation in activities at (or provided through) CBE.
Please type first and last name.
Please type first and last name.
Thu, December 9 2021 5 Tevet 5782