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Member Appreciation Shabbat Service

Friday, June 11, 2021 1 Tammuz 5781

6:30 PM - 8:30 PM


First Name:

Last Name:

Email Contact:

You can also use this form to register children in your immediate household who will be attending with you. (Please note - each adult must complete their own form. Do not list their names here.). This is only the place to list yourself and minor children you are bringing with you. Please provide everyone's full name. Due to social distancing guidelines, we will be unable to admit anyone who does not register in advance. We are sorry, but walk-ins will not be permitted.
Please check the box next to each date you want to attend.

Waiver and Release of Liability Relating to Coronavirus/COVID-19

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is reported to be extremely contagious. The state of medical knowledge is evolving, but the virus is believed to spread from person-to-person contact. People reportedly can be infected and show no symptoms and therefore spread the disease. Evidence has shown that COVID-19 can cause serious and potentially life threatening illness and even death.

B’nai Aviv cannot prevent you or your children from becoming exposed to, contracting, or spreading COVID-19 while utilizing B’nai Aviv’s services or premises. It is not possible to prevent against the presence of the disease. Therefore, if you choose to utilize B’nai Aviv’s services and/or enter onto B’nai Aviv’s premises you may be exposing yourself to and/or increasing your risk of contracting or spreading COVID-19.

Please read the following statements and initial next to the following statements to indicate your agreement.  If you cannot positively affirm to all of these questions, you will be asked to postpone or reschedule your visit to a later date.

ASSUMPTION OF RISK: I have read and understood the above warning concerning COVID-19. I hereby choose to accept the risk of contracting COVID-19 for myself and/or my children in order to utilize B’nai Aviv’s services and enter B’nai Aviv’s premises. These services are of such value to me and/or to my children, that I accept the risk of being exposed to, contracting, and/or spreading COVID-19 in order to utilize B’nai Aviv’s services and premises in person.

WAIVER OF LAWSUIT/LIABILITY: I hereby forever release and waive my right to bring suit against B’nai Aviv and its owners, officers, directors, managers, officials, trustees, agents, employees, or other representatives in connection with exposure, infection, and/or spread of COVID-19 related to utilizing B’nai Aviv’s services and premises. I understand that this waiver means I give up my right to bring any claims including for personal injuries, death, disease or property losses, or any other loss, including but not limited to claims of negligence and give up any claim I may have to seek damages, whether known or unknown, foreseen or unforeseen.

CHOICE OF LAW: I understand and agree that the law of the State of Florida will apply to this contract.

I do not currently, nor have I had in the last two weeks, nor does anyone in my household have/had, a fever, cough, sore throat, loss of smell/taste, difficulty breathing, muscle aches, nausea, vomiting, diarrhea, chills, nasal congestion or other cold symptoms.  

To the best of my knowledge, I, nor anyone in my household, do not have, nor have I/we been in direct contact with someone who has confirmed diagnosis of COVID-19 or a presumptive positive COVID-19 test result in the last 15 (fifteen) days.

Neither I, nor anyone living in my immediate household, have traveled outside of the country in the last 30 days.  

Have you, or any member of your family, tested positive for Covid-19 within the last 30 days OR are you, or any member of your family, currently waiting for your Covid-19 test results?  If the answer is yes - please contact Lynne in the office at 954-384-8265 or at to provide further details to determine if you are able to attend services at this time.
For informational purposes only:  Are you fully vaccinated?  This means that you are at least two weeks post your second vaccine dose if you had Moderna or Pfizer or two weeks post your one vaccine dose if you had J&J.  

By typing your name and date you attest that the above is true and factual.
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Sun, June 13 2021 3 Tammuz 5781