COVID-19 Vaccine Card

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* First Name

* Last Name

Note

Provide legal name if it differs from Vaccine Card name

Confirm email address

Phone Number

XXX-XXX-XXXX

We are collecting this information so we can facilitate access to services, classes and events organized by Congregation Emanu-El. You may choose instead to show evidence of your vaccination status at the door.
If, for technical reasons, we cannot access the database that stores this information, you may be asked to show your vaccine passport and identification when you arrive. Please be patient and respectful of our staff and volunteers.
We will store this data only while we need to verify vaccination status. We will use this information for no purpose other than to facilitate admission to services, classes, and events.

* PLEASE UPLOAD VACCINATION CARD BELOW

You can upload a maximum of 2 files.

Fri, March 31 2023 9 Nisan 5783