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Campus Health Screening and Waiver

We all bear a personal responsibility in preventing the spread of COVID-19. Thank you for your commitment to doing your part in keeping our community healthy and safe. This form must be completed for each person in your nuclear family, who will be accompanying you to the Temple, BEFORE you arrive on campus. This form is timestamped upon completion.

If you are ill in any way, we urge you to stay home and participate virtually. Everyone entering the premises must agree to have their temperature checked. Any person refusing to submit to a temperature check, or with a temperature over 100F, or otherwise visibly ill will be asked to leave discretely and immediately.



The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Association.  COVID-19 is reported to be extremely contagious.  As a result, federal, state and local governments and agencies recommend social distancing and have, in many locations prohibited the congregation of groups of people. We are doing everything we can to be compliant with all regulations and ensure your safety. We have put in place preventative measures to reduce the spread of COVID-19.

Leo Baeck Temple (‘The Temple’) cannot prevent you or your child(ren) from being exposed to, contracting, or spreading COVID-19 while on our premises.  It is not possible to prevent against the presence of the disease.  Therefore, if you choose to attend events or programs at the Temple, you may be exposing yourself to and/or increasing your risk of contracting or spreading COVID-19.

ASSUMPTION OF RISK.  I have read and understood this warning concerning COVID-19.  I hereby choose to accept the risk of contracting COVID-19 for myself and/or my children, including, if I am pregnant, my unborn child(ren), in order to utilize Leo Baeck Temple’s services and enter its premises. 

WAIVER OF LAWSUIT/LIABILITY.  I hereby forever release and waive my right to bring suit against Leo Baeck Temple and its owners, officers, directors, officials, trustees, agents, employees, or other representatives in connection with exposure, infection, and/or spread of COVID-19 related to utilizing Leo Baeck Temple services and premises. 
I understand that this waiver means I give up my right to bring any claims including for personal injuries, death, disease or property losses, or any other loss, including but not limited to claims of negligence and give up any claim I may have to seek damages, whether known or unknown, foreseen or unforeseen. 

CHOICE OF LAW.  I understand and agree that the law of the State of California will apply to this waiver.
Sat, October 31 2020 13 Cheshvan 5781