Covid Vaccination

Congregation Beth Emeth
Covid - 19 Vaccination Policy

As we reopen our building for services and events, it is important to note that we will not be requiring vaccinations to attend any programming. However, the following rules will govern all in-person attendance.

Vaccinated Individuals

Please provide proof of vaccination to CBE. Proof can be in the following forms:

1. A copy or photo of your vaccination card.
2. Showing your vaccination card to any member of CBE’s office staff.
3. Completing the on-line questionnaire (below) for each member of your household who is vaccinated.
This information will be kept confidental.

Unvaccinated Individuals

Face masks are required. Your face mask must be in compliance with CBE’s Mask Policy.

Name (First & Last Name)

Vaccinated:

YesNo

Upload a copy of your card here:

This is optional. You may also enter the information below.

If you would prefer to simply enter the information from you vaccine card, you may do so below.

Vaccinated:

ModernaPfizerJannsen (J&J)

Date of 1st Dose

Date of 2nd Dose

Do you need to enter information for another individual?

Please Select OneYesNo

Name (First & Last Name)

Vaccinated:

YesNo

Upload a copy of your card here:

This is optional. You may also enter the information below.

If you would prefer to simply enter the information from you vaccine card, you may do so below.

Vaccinated:

ModernaPfizerJannsen (J&J)

Date of 1st Dose

Date of 2nd Dose

Do you need to enter information for another individual?

Please Select OneYesNo

Name (First & Last Name)

Vaccinated:

YesNo

Upload a copy of your card here:

This is optional. You may also enter the information below.

If you would prefer to simply enter the information from you vaccine card, you may do so below.

Vaccinated:

ModernaPfizerJannsen (J&J)

Date of 1st Dose

Date of 2nd Dose

Do you need to enter information for another individual?

Please Select OneYesNo

Name (First & Last Name)

Vaccinated:

YesNo

Upload a copy of your card here:

This is optional. You may also enter the information below.

If you would prefer to simply enter the information from you vaccine card, you may do so below.

Vaccinated:

ModernaPfizerJannsen (J&J)

Date of 1st Dose

Date of 2nd Dose

Do you need to enter information for another individual?

Please Select OneYesNo

Name (First & Last Name)

Vaccinated:

YesNo

Upload a copy of your card here:

This is optional. You may also enter the information below.

If you would prefer to simply enter the information from you vaccine card, you may do so below.

Vaccinated:

ModernaPfizerJannsen (J&J)

Date of 1st Dose

Date of 2nd Dose

Do you need to enter information for another individual?

Please Select OneYesNo

Name (First & Last Name)

Vaccinated:

YesNo

Upload a copy of your card here:

This is optional. You may also enter the information below.

If you would prefer to simply enter the information from you vaccine card, you may do so below.

Vaccinated:

ModernaPfizerJannsen (J&J)

Date of 1st Dose

Date of 2nd Dose

I understand that checking this box constitutes a legal signature

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