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Covid Check-In Form

Please answer the following questions to determine your current eligibility to enter the Beth El building. If you have questions or need help completing the form, please contact the Beth El Office at 914-235-2700, ext. 223 or PLEASE NOTE: If multiple members of your household are attending the same event, a separate form MUST be submitted for each person planning to attend. These responses only apply for entries to Beth El within the 12-hour period after you complete it; subsequent entries will require you to complete the questionnaire again.

PLEASE RESPOND TO EACH QUESTION. You must answer “NO” to each question in this questionnaire in order to enter the building. If you answer “YES” to either of the questions, or you answered “NO” to a question but your answer would have changed to “YES" between your completion of this questionnaire and the time of the event, you should not come to the scheduled event.
We appreciate that you wish to join us and thank you for your interest. We look forward to being able to have you join us very shortly!

If you have further questions, please contact us by emailing 
We look forward to having you join us!

By submitting this questionnaire, you certify that all of the answers are accurate to the best of your knowledge, and you will comply with Beth El's guidelines and policies relating to COVID-19.
Sat, June 19 2021 9 Tammuz 5781