Agreement of COVID-19 Policies and Protocols at Ramah Darom

Admin Notes

Please complete and submit one form on behalf of yourself or your entire immediate Household in advance of your arrival to Ramah Darom. If you are registered with members of more than one Household, each individual Household must complete a copy of this form.

Date

Name of the individual completing this form:*

First NameLast Name

Email*

example@example.com

Number of individuals in your Household in attendance at this Retreat (including yourself):*

INSTRUCTIONS:

In order to create a safe environment for everyone, all Retreat attendees must commit to a shared set of COVID-19 prevention protocols. We are all partners in creating a safe and healthy space.

Please read our COVID-19 Prevention Protocols and then initial the agreements below and sign at the end.

Please share these protocols with your entire Household before arriving at Ramah Darom.

I, on behalf of all members of my Household attending the Retreat, agree to the following protocols:

I have read the COVID-19 protocols shared with me by Ramah Darom in advance of the Retreat and that I and all members of my Household in attendance at this Retreat will follow protocols set in place, including any changes or updates that are communicated to me verbally and/or in writing upon my arrival to the Retreat.*

Initial Here

I and all members of my Household in attendance at this Retreat ages 5 and up are fully vaccinated (two weeks post-vaccination) before the start date of the Retreat.*

Initial Here

Please upload vaccination cards for all members of your Household who are in attendance at this Retreat.*

Browse Files

I and the members of my Household ages 3 and older will provide confirmation of a negative PCR nasal swab test upon arrival, with results in within 48 hours of the Retreat.*

Initial Here

I and the members of my Household will wash hands with soap and water for a minimum of 20 seconds before all meals and after going to the bathroom.*

Initial Here

I and the members of my Household will adhere to all masking protocols in place at the Retreat.*

Initial Here

If I or any member of my Household leave the Retreat because I/we are experiencing symptoms of COVID-19, I/we will get tested at our earliest opportunity with an administered PCR nasal swab test and immediately inform Ramah Darom of the results.*

Initial Here

I (and the members of my Household) will inform Ramah Darom of any positive COVID-19 result. Ramah Darom will keep our identity anonymous but will notify all guests who were in attendance during the Retreat with applicable recommendations.*

Initial Here

Are you or anyone in your household in attendance at this Retreat a health care provider or emergency responder?*

NoYes

If you answered "yes" please provide details below:

The signature below indicates that all the above information is accurate.

Signature*

Agreement of COVID-19 Policies and Protocols at Ramah Darom Retreats

INSTRUCTIONS: