SHABBAT SERVICE REGISTRATION FORM - June 19, 2021 - Form

BETH AM SYNAGOGUE
2501 Eutaw Place
Date: 06/19/2021

Please complete this registration form in advance (no later than the Wednesday before the service) in order to attend a Shabbat service at Beth Am Synagogue. There will be no walk-ins!

Only worshippers who have pre-registered will be admitted ; all access is at the Chauncey Avenue entrance.

You will receive a confirmation for the date listed to attend the service.

For now, we are limiting attendance at services to those who are age 16 or over, have been fully vaccinated, and have no outward signs of medical conditions suggesting the possibility of Covid 19.

By attending services at Beth Am, you understand that there is inherent risk in gathering during this time, and you agree to follow the guidelines outlined in these instructions, including wearing a mask at all times and practicing social distancing.

PROTOCOLS AND REQUIREMENTS:
Before registering, you and everyone in your family who is being registered to attend the service should read and be aware of the following guidelines:

Beth Am is following CDC and City of Baltimore guidelines, and reserves the right to cancel, or put additional limitations on, any service if necessary.
Everyone entering the building is expected to have checked their temperature at home. If you are experiencing fever / chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, loss of taste or smell, sore throat, congestion or runny nose, nausea / vomiting, or diarrhea, please stay home. You may be asked on arrival how you feel.
All attendees must maintain 6 feet distance from others. Immediate family members who live together may remain closer than 6 feet to EACH OTHER. A member of the Beth Am Covid Task force and staff will be present to give guidance.
Avoid hand shaking, fist bumps, hugs, and kisses.
All attendees must be masked at all times, except when on the bema chanting or reading publicly from the bema, at the direction of staff / clergy.
Bathrooms and elevators are tight spaces requiring extra vigilance.
Please try to avoid touching surfaces, including mezzuzot, memorial plaques, and the sifrei torah.
Use anti-bacterial hand sanitizer frequently. At a minimum – when you enter the building, whenever you leave the sanctuary – upon your return after using the restroom.
Siddurim, Chumashim, Tallitot, Kipot are available but have not been sanitized.
Attendees with parts in the service will receive instructions from the bema and/or a staff member. In general, a participants will unmask for his / her part, stand distanced at a microphone, and remask before returning to his/her seat.
Singing is permitted as long as attendees remain masked and at their seats.
Following the service there will be no food. Attendees may exchange greetings but remain masked and observing distancing protocols.

REGISTRATION FORM

* First Name

* Last Name

* Address

* City

* State

* Zip Code

* Email Address

* Cell Number

* Vaccinated

Please Select OneYesNo

Would you like an honor ?

What is your Hebrew name ?

LIST ALL ADDITIONAL FAMILY MEMBERS IN YOUR HOUSEHOLD WHO WILL BE SITTING WITH YOU (You do not need to relist yourself.)

Person 1 Details :

Name

Address

City

State

Zip Code

Vaccinated

YesNo

Person 2 Details :

Name

Address

City

State

Zip Code

Vaccinated

YesNo

Person 3 Details :

Name

Address

City

State

Zip Code

Vaccinated

YesNo

Person 4 Details :

Name

Address

City

State

Zip Code

Vaccinated

YesNo

Person 5 Details :

Name

Address

City

State

Zip Code

Vaccinated

YesNo

* All boxes must be checked to complete registration:

I have read the above protocols and requirements and agree that I will follow them, and the instructions of Beth Am staff.I understand that there is a risk in indoor gathering, as defined by the CDC.Everyone in my family that I am registering for the service is over 16 years old, has been vaccinated, and are not currently experiencing symptoms of Covid 19.No one in my family who is attending is experiencing at this time any signs of illness (fever, cough, shortness of breath, difficulty breathing, chills, headache, body ache, sore throat, loss of taste or small, diarrhea, nausea, vomiting).No one in my family will attend the service if he/she has tested positive for COVID-19 in the previous 14 days.We agree to proper wearing of face masks and social distancing.If anyone in my family experiences symptoms within two weeks after the service, we will inform the synagogue.I understand that attending the service is my choice. I release Beth Am Synagogue from any and all liability due to unintentional exposure to or harm from Covid 19.

* SIGNATURE BOX

Please type your full name.