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As Temple Beth Shalom begins to resume in-person gatherings, we are working towards creating a culture of health, safety, and shared accountability. As such, we require a Health Screening form (one per household) each time you or a member of your household will be at an in-person gathering. This applies even if you have received the COVID-19 vaccine. 

Please complete and submit this form no earlier than 24 hours before your intended arrival. In order to be admitted, you will be required to show this form's dated confirmation email.
Please fill out the following information. Please use an email that is available to you, as we will be sending a confirmation. This dated confirmation email is required in order to enter our building.

- Cough
- Shortness of breath or difficulty breathing
- Chills
- Repeated shaking with chills
- Muscle pain
- Headache
- Sore throat
- Loss of taste or smell
- Diarrhea
- Feeling feverish or a measured temperature greater than or equal to 100.0 degrees Fahrenheit
- Known close contact with a person who is lab confirmed to have COVID-19




Please stay home and get well. Unfortunately, we will not be able to allow you entry. For more information, please reach out to our
Executive Director, Patti Bridwell.






























































































 
Please click the "I attest" message on the button below in order to submit your form.

 

Fri, May 14 2021 3 Sivan 5781