Health Form

The form below MUST be completed once you have made an appointment with Mark Krieger to visit the Gemach, but before your actual visit.

If you have not completed this form, you will not be permitted to enter the Gemach.

If you do not agree to wear a mask, practice social distancing and understand the Gemach rules regarding donations/refunds, you will not be permitted to visit the Gemach.

If any of your answers change between the time you complete this form and your appointment, you MUST inform Mark Krieger by phone at 917-703-4694.