Shabbat Service Registration - Form - Suburban Temple

Our sanctuary is OPEN for Friday night Shabbat services and we look forward to seeing you in person! Keeping the health and well-being of all congregants, staff, and visitors in mind, please complete the below registration to attend ST-KA's Shabbat services.

While registration is not REQUIRED, we do ask that you register so that we know who is in attendance. This is of particular concern with the recent increase in COVID-19 transmission in Cuyahoga County.

If you have questions or need help completing the form, please contact Charlotte Versagi at 216-991-0700 or by email at cversagi@suburbantemple.org.

Please include the name of each person planning to attend. Thank you!

* Which service(s) would you like to attend?

* Names of Attendees

* Please select one of the following options

Please Select OneI/We are up to date in vaccinations against COVID-19I/We are NOT vaccinated. (Please join us online)Our vaccination status is blended. (Please join us online)

I have will complete the vaccination form and upload my proof of vaccination

YesNohttp://www.suburbantemple.org/form/vaccine-status.html

* I agree to follow established ST-KA guidelines regarding mask wearing and social distancing.

Please Select OneYesNo

* Do you confirm that in the past 14 days, you have NOT had a fever, new cough, runny nose (different from seasonal allergies) or sore throat?

Please Select OneYes, I confirm the aboveNo, I cannot confirm the above

* I agree to each statement above and understand that attending any service at ST-KA is my choice. I therefore release Suburban Temple - Kol Ami and its directors, officers, employees, agents, volunteers, sponsors and representatives from any and all liability for the unintentional exposure or harm due to COVID-19. Moreover, if my answers to any of the questions on this registration change between the time I complete it and the service for which I have signed up for, I will contact the ST-KA office and will not attend until I have heard back from ST-KA that it is safe to do so.

Please Select OneYesNo

* First Name

* Last Name

* Email

* Phone Number