Minyan registration, Shabbat, July 11, woman in Main Shul at 9 am

Name*
First Last
Email*
Cell phone*
Are you a member of Great Neck Synagogue?*
Age Recommendation
Medical professionals have advised that individuals age 65 and older are at an increased risk for contracting the Covid 19 virus. For information regarding children under 13 please contact one of the Rabbis.
Are you aware of the increased risk for contracting Covid 19 if you have any of the following conditions?*
- a) Immuno-compromised
- b) Chronic lung disease
- c) Cardiovascular disease
- d) Diabetes
- e) Chronic kidney disease requiring dialysis
- f) Severe obesity defined as Body Mass Index >40 (Calculator available on line)
- Yes, I am aware of these risk factors
Have you experienced any of the below symptoms in the past 14 days?
- a) Fever >100 degrees
- b) Chills
- c) Muscle pain
- d) Cough
- e) Shortness of breath
- f) Headache
- g) Sore throat
- h) Runny nose
- i) Diarrhea
- j) Vomiting
- k) New loss of taste or smell
Have you had close contact or cared for someone diagnosed with or suspected to have COVIOD-19 within the past 14 days? Medical professional who wear PPE should answer NO,
By registering, you agree that you have read and agree to comply with the terms and conditions for participation (available at https://www.gns.org/guidelines-for-shabbat-minyan-attendance/), are participating at your own risk, and expressly disclaim Great Neck Synagogue and its officers, trustees and employees of any liability*