Tisha B'Av Program -- 8/6/22 at 8

* 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.

Please note: If you need to use the outside elevator to get upstairs or downstairs into the building, email Alan at alan.shusterman@hillhavurah.org in advance to arrange for it to be unlocked for you.

Sat, December 2 2023 19 Kislev 5784