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COVID-19 Registration Form to Attend In-Person
Services & Events at Congregation Beth El Norwalk
(Note: Registrations are due by 4pm the Thursday prior to the Service date)

Please complete this registration form in order to attend a service or special event at Congregation Beth El Norwalk (CBE). If you are fully vaccinated (a minimum of two weeks past final dose) you only need to complete this form once if you provide the requested information below.

A separate form MUST be submitted for each person planning to attend the service or event, regardless of age.

Registration is valid only for the service or special event and on the date listed in this form.

Safety Protocols and Requirements for Entry

Fully vaccinated attendees may choose to not wear a mask and may choose to sit next to other vaccinated attendees in sections of the sanctuary reserved solely for vaccinated attendees.
All non-vaccinated attendees must follow CDC guidelines by wearing a face mask that covers both mouth and nose at all times while on the CBE premises. Face masks must be provided by the individual and will not be made available by the synagogue.
All non-vaccinated attendees will be seated in sections of the sanctuary reserved solely for non-vaccinated attendees, and will be seated at least 6 feet from any other person or family pod in these sections.
All non-vaccinated attendees must maintain at least 6 feet distance with all others, except for immediate family members living in the same household, caretakers, or romantic partners.
All attendees bringing children to the CBE premises must take responsibility for ensuring that non-vaccinated children over the age of 2 wear masks and remain socially distanced from other households at all times.
All non-vaccinated attendees agree to refrain from any physical contact between themselves and other guests, except among immediate family members living in the same household, caretakers, or romantic partners. This includes hand shaking (even with gloves), fist bumps, hugs, and kisses.

* First Name

* Last Name

* Email Address

* Best Phone Contact

* Address where you live (including State)

*All boxes must be checked to attend

* I confirm that I am a member of CBE or an invited guest of a member.

I confirm that I am a member of CBE or an invited guest of a member.

* I have read the safety protocols set forth above and agree that I will adhere to all of the safety protocols and requirements for entry set forth by CBE, including any directives given to me while at the service.

I have read the safety protocols set forth above and agree that I will adhere to all of the safety protocols and requirements for entry set forth by CBE, including any directives given to me while at the service.

Unless I am fully vaccinated (minimum 2 weeks past your final dose), I affirm that I will not enter CBE if

a) I tested positive or been diagnosed as presumptively positive for COVID-19 in the last 10 days -- and will not attend until I have fully recovered
b) I was directly exposed to someone who has tested positive or been diagnosed as presumptive positive for COVID-19 in the last 10 days, or
c) In the last seven days, I or anyone I reside with, had any of the CDC listed COVID-19 symptoms that cannot be explained by an existing underlying medical issue.

* I understand that CBE is instituting extensive and reasonable safety protocols and precautions to create a safe and healthy environment for all guests. However, despite CBE’s best efforts, I understand that CBE cannot guarantee that I will not become infected with COVID-19 while attending a service or event at CBE. By attending this service or event, I hereby release, hold harmless, and waive my right to bring suit against CBE due to any potential exposure to COVID-19 in connection with my attendance at CBE.

I understand that CBE is instituting extensive and reasonable safety protocols and precautions to create a safe and healthy environment for all guests. However, despite CBE’s best efforts, I understand that CBE cannot guarantee that I will not become infected with COVID-19 while attending a service or event at CBE. By attending this service or event, I hereby release, hold harmless, and waive my right to bring suit against CBE due to any potential exposure to COVID-19 in connection with my attendance at CBE.

Vaccination Status

Vaccination StatusI affirm that I am fully vaccinated (a minimum of two weeks past my final dose).

Vaccination Date: My final vaccination dose was on:

Providing your vaccination information to us is completely voluntary and all information will be stored securely by CBE. If you do not provide this information to us, we expect you will follow the protocols identified herein for non-vaccinated attendees.

* If you are not fully vaccinated, please list the service you wish to attend and the date.

Registration is for the upcoming weekend only

If you are not fully vaccinated, please list the immediate family members (including children) of the same household who will sit with you.

Please note, each family member must register separately.

Fri, April 19 2024
11 Nisan 5784

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Contact Us

Email: Click HERE

Phone: 203-838-2710

Fri, April 19 2024 11 Nisan 5784