Covid-19 Safety Questionnaire

Please fill out the form below EACH time you attend an event at the Temple. The form will be used for contact tracing purposes and information will not be sold or distributed to any third party.


COVID-19 Safety Questionnaire

Participants First & Last Name(Required)
MM slash DD slash YYYY
Are you fully vaccinated for Covid-19?(Required)
If you are NOT fully vaccinated against Covid-19, you may not attend in-person Temple events.
Are you experiencing any covid-19 symptoms?(Required)
Symptoms may include: Fever or chills • Cough • Shortness of breath or difficulty breathing • Fatigue • Muscle or body aches • Headache • Recent loss of taste or smell • Sore throat • Congestion • Nausea or vomiting • Diarrhea
To the best of my knowledge, within the past 10 days, I HAVE NOT been in close contact with anyone who has tested positive for Covid-19(Required)