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Registration Form for Indoor Shabbat Services Services during Pandemic

Thank you for taking the time to register for Shabbat Services.
We are sure you understand that during this time, everyone must adhere to strict health and safety standards.

Please note: the main contact for each family needs to complete and submit this form.  We only need one registration form for each family, listing the names of all those who will attend.

Anyone who is eligible to receive the COVID-19 vaccine (those age 16 and older) are required to show proof of vaccination.  Unvaccinated children younger than 16 may attend.

We encourage you to fill out this form using the device where you keep your photos. 
For most of you, this will most likely be your mobile phone.

This email address will receive your confirmation message.

Please upload a copy of the vaccination card for each person who will be attending services.  You may use this box to upload multiple files; simply click again inside the box.  Those under the age of 16 do NOT need to provide proof of vaccination.

If you are not able to provide proof of COVID-19 vaccination, you must provide a negative COVID PCR test within 48 hours of services.  You may upload a copy of your test result here, or bring it with you when you attend.  Those under the age of 16 do NOT need to provide a negative COVID test).

  • Everyone in our family will bring and properly wear a mask over the nose and mouth for the duration of our time at the GRJC;
  • We agree to maintain standard six-foot distancing from others;
  • We understand that no food or drink will be allowed in the building;
  • No one in our family will attend if they are exhibiting any of the following symptoms: cough, shortness of breath, headache, fever, muscle pain, chills, sudden loss of taste or smell;
  • I understand that my family will be required to do a Wellness Check upon our arrival, which includes temperature checks.  If anyone in our family has a fever, no one in our family will be allowed entrance to the building;
  • If I travel internationally (regardless of my vaccination status), I will quarantine for 10 days from the day after my return and be PCR (not rapid) tested after Day 5 (Day 1 being the day following my return).  Assuming I am asymptomatic and my PCR test comes back negative, I will be able to attend;
  • If I host guests from anywhere other than NY, NJ, CT, DE or PA who are NOT FULLY VACCINATED, I will quarantine for 10 days (from the day of my guests' arrival) with PCR testing after Day 5 of my guests' arrival.  Assuming I am asymptomatic and my PCR test comes back negative, I will be able to attend.

ECC Coronavirus/COVID-19 Waiver


The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited or limited the congregation of groups of people.

Glen Rock Jewish Center has put in place preventative measures to reduce the spread of COVID-19; however, GRJC cannot guarantee that you or anyone in your family will not become infected with COVID-19. Further, attending GRJC in-person activities could increase your risk and your family’s risk of contracting COVID-19.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my family and I may be exposed to or infected by COVID-19 by attending GRJC-related activities and that such exposure or infection may result in personal injury, illness, permanent disability and death. I understand that the risk of becoming exposed to or infected by COVID-19 at GRJC-related activities may result from the actions, omissions, or negligence of myself and others, including, but not limited to, GRJC employees, volunteers, and GRJC-related activity participants and their families.

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my family or myself (including, but not limited to), personal injury, disability and death, illness, damage, loss, claim, liability, or expense, of any kind, that I or my family may experience or incur in connection with my our attendance at GRJC or participation in GRJC-related activities (“Claims”). On my behalf, and on behalf of my children under the age of 18 years, I hereby release, covenant not to sue, discharge, and hold harmless GRJC, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of GRJC, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any GRJC-related activity.

I understand and agree that the law of the State of New Jersey will apply to this Waiver of Liability.


Thu, May 13 2021 2 Sivan 5781