Orthodox Service

The total number of persons who may attend each event/service is strictly limited by Government regulations and ACTJC policy. Completing and submitting an application does NOT guarantee that you will be permitted to attend the event/service. You may attend the event/service ONLY if you receive formal notification from the ACTJC BEFOREHAND that your application has been accepted, and you comply with entry conditions. Otherwise, you will be turned away. Admission to each event/service will be strictly monitored and controlled.

Event Name:

Commencement Time:

Any special reason for attendance (eg yahrzeit, other anniversary etc):

* First Name

* Surname

* Email

Mobile:

How many people are attending

COVID-19 risk factors

[Please check each box only if the statement is true. Otherwise, leave the box unchecked.]

COVID-19 risk factors

I have not returned from overseas in the last monthNo member of my household has returned from overseas in the last 14 daysI have not returned a positive test for the COVID-19 virus for at least 28 daysI have not during the last 14 days had a persistent cough, sore throat, persistent sneezing, persistent blocked or runny nose, or temperature exceeding 37.5 degrees Celsius, or experienced any loss of smell or tasteTo the best of my knowledge, I have not been in physical proximity (1.5 metres or less) to any person who has returned a positive test for the COVID-19 virus in the last 28 days

By completing this form, I am agreeing to each of the statements accompanying the boxes checked below

[Please check the box of each statement to which you agree. Leaving a box unchecked may result in your application not being accepted]

I will use only my own kippah, tallit, tefillin, siddur, machzor or chumash, and not any item used by any other person or by the synagogue.

Throughout the time of my attendance at the synagogue, except when entering or leaving, I will remain in one seat, unless called to the Bimah or otherwise directed by synagogue staff.

Throughout the time of my attendance at the synagogue, and when entering and leaving, I will immediately and fully comply with all directions of synagogue staff.

Throughout the time of my attendance at the synagogue, and when entering and leaving, I will practise social distancing by strictly observing the rule of no more than one person per 4 square metres, and maintaining a physical distance of at least 1.5 metres from all other persons. This will also apply if I am called to the Bimah.

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.

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.

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 synagogue of full details of the changed circumstances.

Friday, 5 June, 2020 • 13 Sivan 5780