Brotherhood Clean Up Event

* First Name

* Last Name

* Email Address

* Have you or anyone in your family/household had contact with others, or been caring for someone, who experienced any of the above symptoms or was diagnosed with COVID-19 within the last 14 days?

YesNo

* Do you or have you or anyone in your family/household had any of the following symptoms within the last 24 hours: Fever or feeling feverish (chills, sweating), New cough, Difficulty breathing, Sore throat, Muscle aches or body aches, Vomiting or diarrhea, New loss of taste or smell, or extreme fatigue?

YesNo

If you have answered "yes" to either of the two health screening questions above, please stop here and check this box that you understand you do not meet the health screening requirements to attend this event. If you answered "no" to both of the above, please proceed to the following set of questions.If you do not meet our screening requirements, we are sorry, but in order to ensure the health and safety of our congregants, we must ask you to participate in this event remotely. If you have any questions or concerns, please contact CST's Executive Director, Lorelei Berg (248) 649-4418 x 1, or our Board President, Patty Rehfus (248) 219-6615 .

* I/we understand that in order to gain entrance into this event I/we must comply with the following (please check each to confirm your consent):

I/we will bring my/our own face mask/covering and wear it throughout the duration of the event and assist/monitor any children in your family/household in wearing theirs.Remain 6 feet apart "socially distanced" from anyone that is not my family/household.Receive a brief health screening (re-certifictation that none of the symptoms above are present) including a temperature check and a sign-in sheet (for contact tracing purposes).Anyone who participates in a CST-sponsored event must notify CST immediately if, within 4 weeks of the event, they develop symptoms of Coronavirus Disease or receive a positive result from a COVID-19 test and/or have close contact with someone who developIf I do not comply with any/all of the above I will not be able to attend the event.

* Please indicate the names of people in your family/household that will be attending this event.

* Please enter the number of people from your family/household attending this event.

Sunday, April 11, 2021 • 29 Nisan 5781

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