Lag B'Omer Picnic -- 5/8/23 at 6

* Your First and Last Name:

* Your Email Address:

* Your Phone Number:

By checking the above box, I attest that I have read and will be fully vaccinated and in compliance with Hill Havurah's Updated COVID Policy when I attend this in-person event. Furthermore, I attest that the preceding is true for any other adult(s) who attend(s) this event with me.

First and Last Name(s) of Any Other Adult(s) Who Will Be Attending:

First and Last Name(s) of Child/Children Who Will Be Attending (followed with their age in parentheses, please) -- e.g., Joey Cohen (3).

If you have any questions, please contact Alan at alan.shusterman@hillhavurah.org. Thanks.

Please note: We are all responsible for one another and, therefore, we ask that you let us know either personally or through a 3rd party if you test positive for Covid following attendance at one of our in-person events. Thank you.

Sat, June 7 2025 11 Sivan 5785

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