Beth Shalom High Holiday Ticket Order Form and Youth Tefillah (Services) & Babysitting High Holiday RSVP Form

I attest that each individual in my immediate family or family guest, which I am ordering a ticket for, has been fully vaccinated or are ages 0 to 11. I also agree to enforce all safety protocols for myself and, if applicable, for everyone I am ordering tickets for and agree to wear a mask, except for children ages 0 to 2. Additionally, I agree to instruct my children, ages 6 and up, to either be engaged in youth programming or be in the main adult service. I understand that NO CHILDREN are to be wandering the building without parental supervision. (Enter full name below.) *

Check box below that applies. *

I have previously sent in a vaccination card for each applicable individual
I will email a copy of a vaccination card for each applicable individual not previously provided to Tika at receptionist@bethshalompgh.org
Other

If Other, please explain below if you have special circumstances

Electronic Signature (enter full name) *

Date *

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone *

Cell Phone *

Email *

Enter the first and last name, including yours, of each person that will be attending Beth Shalom in-person during the holidays, including all adults and children. Guest tickets are $100 each. Please enclose a check for any guest tickets requested, payable to CBS.

Adult 1 Name *

Adult 2 Name (Enter NA if not applicable) *

Child 1 Name (Enter NA if not applicable) *

Child 2 Name (Enter NA if not applicable) *

Child 3 Name (Enter NA if not applicable) *

Child 4 Name (Enter NA if not applicable) *

Guest 1 Name (Enter NA if not applicable) *

Guest 2 Name (Enter NA if not applicable) *

Guest Tickets (Guest tickets are $100 each.)

$100.00 (1 guest ticket)
$200.00 (2 guest tickets)

Total Amount

$0.00

Please indicate if your child(ren) will be attending youth services or enrolling in babysitting.

Are you bringing children ages 6 months to 13 years old? *

YES
NO

If yes, the below information is required to complete.

Child 1 Name

Child 1 Age

Child 2 Name

Child 2 Age

Child 3 Name

Child 3 Age

Child 4 Name

Child 4 Age

Attending Rosh Hashanah Day 1? (applies to all children listed above)

YES
NO

Attending Rosh Hashanah Day 2? (applies to all children listed above)

YES
NO

Attending Kol Nidrei? (applies to all children listed above)

YES
NO

Attending Yom Kippur Day? (applies to all children listed above)

YES
NO

Beth Shalom High Holiday Ticket Order Form and Youth Tefillah (Services) & Babysitting High Holiday RSVP Form

Congregation Beth Shalom is looking forward to welcoming children back

Enter the first and last name, including yours, of each person that will be attending Beth Shalom in-person during the holidays, including all adults and children. Guest tickets are $100 each. Please enclose a check for any guest tickets requested, payable to CBS.

Please indicate if your child(ren) will be attending youth services or enrolling in babysitting.

If yes, the below information is required to complete.