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Welcome
COVID-19 Information and Vaccination Form
Please verify reCaptcha before submitting the form.
*
First Name
*
Last Name
*
Email
In order to attend in-person Suburban Temple - Kol Ami programming, proof of COVID-19 vaccination is required for ages 5+. There will be a grace period of 60 days from either a birthday making one eligible to receive your vaccine. It is our belief that vaccinations, including all eligible boosters, are a critical tool in the fight against COVID-19 and we encourage all to be "up to date" on vaccinations.
If your proof of vaccination is not submitted before coming to Temple, you will be required to show proof upon arrival.
People are considered
fully vaccinated
: 2 weeks after their second dose in a 2-dose series, like the Pfizer or Moderna vaccines, or 2 weeks after a single-dose vaccine, like Johnson & Johnson’s vaccine.
A person is considered "
up to date
" if they have received a booster. At this time, the CDC recommends that all adults (ages 18+) receive a mRNA booster (Pfizer or Moderna). Children ages 12+ who received the Pfizer vaccine are eligible to receive the Pfilzer booster. (*as of 1/12/2022 per CDC.gov)
If you have not/are unable to receive a booster and wish to attend in person programming, please contact
Brett Shankman
.
We are following CDC guidance on masking. While Cuyahoga County is a "low" transmission county or "green", masks will be optional in the building. Thank you.
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Adult 1 First Name
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Adult 1 Last Name
*
Vaccination Status (choose only 1)
Adult 1 is fully vaccinated
Adult 1 is up to date
*
Date of Final Vaccine
Upload Adult 1's Vaccine Card
Adult 2 First Name
Adult 2 Last Name
Vaccination Status (choose only 1)
Adult 2 is fully vaccinated
Adult 2 is up to date
Date of Final Vaccine
Upload Adult 2's Vaccine Card
Child 1 First Name
Child 1 Last Name
Vaccination Status (choose only 1)
Child 1 is fully vaccinated
Child 1 is up to date
Date of final vaccination
Upload Child 1's vaccination card
Child 2 First Name
Child 2 Last Name
Vaccination Status (choose only 1)
Child 2 is fully vaccinated
Child 2 is up to date
Date of final vaccination
Upload Child 2's vaccination card
Please note any other members of your family who have been fully vaccinated and/or are up to date
Upload any additional vaccination cards
Mon, February 6 2023 15 Sh'vat 5783