Thank you for your interest in attending TNT Service or other programs. Please fill out this survey 2-3 hours before you plan to attend a program or service at TNT to confirm your health and attendance. 

TNT Service signup
Temple Ner Tamid 
Friday, (Date) 
8:00 PM 

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* 1. Your contact info:

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* 2. Do you now have or in the past 48 hours have had a temperature of 100.4F or greater?

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* 3. Do you have a cough? (new onset, or worsening in the past 48 hours?)

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* 4. Are you short of breath? (New onset, or worsening in the past 48 hours.)

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* 5. Have you been in direct contact with anyone who has the above symptoms or has been diagnosed with COVID - 19 within the past 14 days?

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* 6. Have you lost your sense of smell?

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* 7. Have you recently developed any abdominal pain &/or diarrhea not consistent with a pre existing condition. 

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* 8. My answers are truthful and answered to the best of my ability.

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* 9. I understand that If I answered yes to any of questions 4-9, that I need to call my healthcare provider for medical advice and to provide medical authorization in the form of written communication for me to attend future services or programs at TNT. Alternatively, I will provide proof of a negative Covid-19 test. Until that time, I will not attend Services, programs or enter the TNT building.

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* 10. I understand that I am expected to wear a mask when I am in the Synagogue Building - I will not bring any food or drink - I understand that I am not permitted to sing while in the Synagogue. I agree to abide by all Policies and Procedures set forth by TNT

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* 11. I understand that there will be a limited number of attendees allowed to attend the services or programs and that I will not attend or show up at the Temple if my attendance has not been confirmed by TNT in advance.

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* 12. This form must be filled out 2 to 3 hours before the Service or program. 

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