Covid Vaccine Card - Form - Kol Tikvah

Covid Vaccine Card

Thank you for submitting your Covid Vaccine Card for us to keep on file. Having this information will help us welcome our members in person with safety and efficiency in mind.

Use this form to submit cards for up to 6 people in your family.

Note: These cards will be stored confidentially and will not be visible in the member directory.

First Name

Last Name

Email

Vaccine Card Image

First Name

Last Name

Vaccine Card Image

First Name

Last Name

Vaccine Card Image

First Name

Last Name

Vaccine Card Image

First Name

Last Name

Vaccine Card Image

First Name

Last Name

Vaccine Card Image

If you are attending a private event as a guest, please provide the name of the event/member:

Date of event:

Wed, December 6 2023 23 Kislev 5784

Kol Tikvah is a member of the Union for Reform Judaism and opens its doors to families of all types - Traditional, LGBTQ, Interfaith, and Dual Faith.

CONTACT US
20400 Ventura Blvd, Woodland Hills, CA 91364
Phone: 818.348.0670
Email: frontdesk@koltikvah.org

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