Covid-19 Vaccination Upload Form - Form - Congregation Beth Am Israel

Covid-19 Vaccination Upload Form

* First and Last Name:

* Email

* Phone Number:

At this time we will be requiring proof of vaccine for all in person indoor services and everyone will also still be required to wear a mask over their mouth and nose. Please note that children under 12 are welcome but all children over 2, must be masked and no babysitting will be available at this time.

As always if you have had a close contact or are exhibiting symptoms of Covid-19, we ask that you not join us in person and instead join us on Zoom. You can find our full reopening guidelines here.

Please note that we will keep your vaccine card on file. If you have questions about our procedures or prefer to show your card in person to the office, please contact us at office@bethamisrael.org.

B'Shalom,

Your Beth Am Israel Community

* Please indicate how many people you will be registering:

Please choose one:

I am a congregantI am a guestI am not a guest or congregant and would like to join BAI at your service/programI am a prospective member

Please indicate below if you have already uploaded your card and this is to update with booster information

I have previously uploaded my card and this is to update my booster information.

1. Name

Please upload proof of full vaccination for each eligible member of your group

You can upload a maximum of 1 files.
Please note that your card must reflect a full vaccination (ie. at least 2 doses of Moderna or Pfizer or 1 dose of J&J covid-19 vaccine)
Eligible participants reflect anyone over the age of 12.

2. Name

Please check here if this is a child who is not eligible

Please check here if this is a child who is not eligible

Please upload proof of full vaccination for each eligible member of your group

You can upload a maximum of 1 files.

3. Name

Please check here if this is a child who is not eligible

Please check here if this is a child who is not eligible

Please upload proof of full vaccination for each eligible member of your group

You can upload a maximum of 1 files.

4. Name

Please check here if this is a child who is not eligible

Please check here if this is a child who is not eligible

Please upload proof of full vaccination for each eligible member of your group

You can upload a maximum of 1 files.

5. Name

Please check here if this is a child who is not eligible

Please check here if this is a child who is not eligible

Please upload proof of full vaccination for each eligible member of your group

You can upload a maximum of 1 files.

6. Name

Please check here if this is a child who is not eligible

Please check here if this is a child who is not eligible

Please upload proof of full vaccination for each eligible member of your group

You can upload a maximum of 1 files.

7. Name

Please check here if this is a child who is not eligible

Please check here if this is a child who is not eligible

Please upload proof of full vaccination for each eligible member of your group

You can upload a maximum of 1 files.

Thu, May 9 2024
1 Iyyar 5784

Thu, May 9 2024 1 Iyyar 5784

Congregation Beth Am Israel
Building Meaningful Jewish Lives Together.
610-667-1651
1301 Hagys Ford Road
Penn Valley, PA 19072
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