COVID-SAFE - Prayer's in Memory of Jacqueline Desiree Shotland OBM

The following screening questions relate to any persons that I may have come in close contact with (eg. family or friends, co-workers, home visitors such as cleaners or guests etc.)

By submitting this form, I agree to each of the following terms and conditions:

1. On arrival at the synagogue (and throughout the time of my attendance): 
   
   
   • I will provide my correct name to security and/or synagogue personnel.
      
   • I will immediately and fully comply with all directions of synagogue staff.
      
   • I will practise social distancing by strictly observing the rule of at least 1.5 metres from all other persons, including family members and friends.
      
   • I will remain in one seat, unless otherwise necessary (eg. to use toilets, entering or exiting).
      
   • I will not engage in hand-shaking, hugging, kissing or moving around to greet people or socialise.
      
   • I will not linger, or join in gathering with any other people (including in the synagogue precincts).
               
2. I understand that if I have a temperature of 37.5C or higher I/we will not attend Shul.
   
   
3. I intend to stay for the complete duration of the service. 
    
4. I am the applicant, and I have personally completed all items in this application form.
    
5. I consent to the synagogue collecting, storing, using and disclosing my personal information (including my health information) solely for the purposes of assessing this application, and to any government health official on request.
   [Note: The synagogue intends to retain the information until the government declares an end to the risk of COVID-19 infection by community spread, after which all records of such information will be destroyed.]
    
6. I warrant that the information I have provided is true and correct to the best of my knowledge, and that I have not knowingly provided information which is false, misleading or incomplete. 
    
7. I understand that the synagogue, its office-bearers, clergy, staff and contractors, and other persons attending the service, will rely on the truth and accuracy of the information I have provided in this application, in seeking to mitigate the risk of COVID-19 infection by community spread within the synagogue and its precincts, and the risk of severe or lethal consequences if infection occurs.
    
8. If, between the time of submitting this application to the synagogue and the scheduled time of commencement of the service I wish to attend, my circumstances change in any way that would result in any information I have provided no longer being true, correct and complete, I will immediately notify the Rabbi, or the synagogue office of full details of the changed circumstances. I will not attend if there is an increase in my COVID-19 risk factors as detailed above.

Completing and submitting this application does NOT guarantee that you will be able to attend.

You may ONLY attend the service if you receive a formal notification IN ADVANCE that your application was successful, otherwise you will unfortunately have to be turned away.