Our Community's Health: Vaccination Status

Our congregants live throughout the larger Sacramento region, and they range in age and health. Pre-COVID, what traditionally helped us build community was our ability to sit (or stand) close to each other, sing, laugh, and eat together during our worship services and programs. We have erred on the side of caution and suspended in-person gatherings for worship, lifecycle events, educational programs and social events.

In partnership, the Senior Staff and Executive Committee review emerging scientific evidence and evolving governmental policies to make appropriate decisions on how we can cautiously continue with in-person services and programs.

We respectfully ask that each member of your household voluntarily complete this form to indicate their vaccination status.

If you have already uploaded your CDC card, please only resubmit your status if there is an update (i.e. you received the booster shot).

Please note individual statuses will be held in STRICT confidence.

Please visit our COVID update webpage for current guidelines.

Adult 1 First Name

Adult 1 Last Name

Adult #1 vaccination status:

Please Select OneONLY received Shot #1 and Shot #2Received Shot #1, #2 AND the BoosterNone of the above

Adult 2 First Name

Adult 2 Last Name

Adult #2 vaccination status:

Please Select OneONLY received Shot #1 and Shot #2Received Shot #1, #2 AND the BoosterNone of the above

Child 1 First Name

Child 1 Last Name

Child 2 First Name

Child 2 Last Name

Child 3 First Name

Child 3 Last Name

Please note any other members of your household who have been fully vaccinated

CONGREGATION B'NAI ISRAEL

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