Vaccine Status

* Last Name on Vaccine Card

* First Name on Vaccine Card (& middle initial/name if present)

* Email (for confirmation and any needed followup):

Note: People are considered fully vaccinated: 2 weeks after their second dose in a 2-dose series, like the Pfizer or Moderna vaccines, or 2 weeks after a single-dose vaccine, like Johnson & Johnson’s Janssen vaccine.

* Is this person fully vaccinated, or will this person be fully vaccinated prior to attending event at CBE?

Please do not fill out the form at this time. Please submit the form when this person is considered to be fully vaccinated, as defined above.

* Date of Final Vaccine

* Does this Vaccine Card include a booster shot?

Please Select OneYesNo

* Are you submitting your proof of vaccination for a one-time event ONLY? (Bar/Bat Mitzvah, wedding, etc.-- including if the event includes a few consecutive days)

Please Select OneYesNo

Date of special event at Beth Emeth

(If your event is multi-day, please enter the last date)

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