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In order to uphold our highest Jewish value, Pikuach Nefesh (Safeguarding Human Life), Congregation B’nai Israel (CBI) requires preregistration for all in-person gatherings. This form must be submitted via the CBI website 24 hours prior to the event.

NO ONE WILL BE ALLOWED TO ENTER THE BUILDING WITHOUT HAVING REGISTERED IN ADVANCE.

Please respond to the following statements by marking the appropriate box. Please answer carefully; the safety of our community depends on you.

1. Within the past 14 days, have you or anyone in your household been diagnosed with Covid-19?
YESNO
2. Within the past 14 days, have you had contact with anyone who has been diagnosed with OR is under investigation for Covid-19?
YESNO
3. Have you traveled outside the State of Arkansas within the past 14 days?
YESNO
4. Within the past 14 days, have you experienced ANY of the following symptoms: fever (100.4o or higher), cough, shortness of breath, loss of smell or taste?
YESNO

IF ANY OF THE ABOVE STATEMENTS ARE MARKED “YES”, YOU ARE PROHIBITED FROM ENTERING THE CBI BUILDING.

The novel coronavirus, Covid-19, has been declared a worldwide pandemic by the World Health Organization. Covid-19 is extremely contagious and is believed to spread mainly from person-to-person contact. Attending any event at CBI could increase your risk and your family’s risk of contracting Covid-19.

By my signature below, I affirm the information on this form is true and complete to the best of my knowledge. I further affirm and promise that if, on the day of the event, I am experiencing fever, cough, sore throat, “sniffling”, malaise, or shortness of breath, I will not seek to enter the CBI building.

By signing this agreement, I acknowledge the contagious nature of Covid-19 and voluntarily assume the risk that I and my child(ren) may be exposed to or infected by Covid-19 while attending CBI and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by Covid-19 at CBI may result from the actions, omissions, or negligence of myself and others including, but not limited to, CBI employees, volunteers, program participants and their families.
I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself including, but not limited to, personal injury, disability, and death, illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my attendance at CBI.

On my behalf, and on behalf of my child(ren), I hereby release, covenant not to sue, discharge and hold harmless Congregation B’nai Israel, its employees, agents, officers, directors, and representatives, of and from any claims, liabilities, actions, damages, costs or expenses of any kind arising out of or relating thereto my or our attendance at CBI.

I understand and agree that this release includes any claims based on the actions, omissions, or negligence of CBI, its employees, agents, officers, directors, or representatives, whether a Covid-19 infection occurs before, during, or after attendance at any CBI program or event.

By signing here, I agree to the above assumption of the risk and waiver of liability relating to Covid-19: