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Health Certification Form for Employees, Congregants and Visitors

I would like to enter the Scarsdale Synagogue Temples Tremont and Emanu-El building.  I understand that, in light of the COVID-19 pandemic, Scarsdale Synagogue will not allow any employee, congregant or visitor, including me, to enter the building if such employee, congregant or visitor answers “YES” to any of the following statements.  I also recognize that any employee, congregant or visitor, including me, will be denied entry if the Scarsdale Synagogue staff or its clergy reasonably believe that I am experiencing symptoms of COVID-19. 

I hereby certify that I am accurately answering all of the following statements:

I have been advised and I understand that Scarsdale Synagogue cannot guarantee a completely COVID-19 free environment and that, if I consider myself to be high-risk for COVID-19, I should not enter the Scarsdale Synagogue building.  By signing below I acknowledge and agree that, to the maximum extent permitted by law, Scarsdale Synagogue shall have no liability if I am exposed to or contract COVID-19 as a result of my presence in the Scasdale Synagogue building.

Wed, July 24 2024 18 Tammuz 5784