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Bulletin & Program Guide
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What’s Next? How to Become a Part of Our Community
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Religious School Registration Form
Child's First Name
Child's Last Name
Child's Hebrew Name
Child's Grade as of 9/21
Child's Primary Mailing Address
Address Line 2
District of Columbia
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
If your child does not have a Hebrew name, do you need help choosing them?
Does your child have any allergies or other medical condition of which we should be aware?
If yes: Please describe them and indicate special precautions or care needed (i.e., Epi-pen).
Medical Condition Consent
As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Congregation Emanu-El of Westchester to secure medical treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, the staff of Congregation Emanu-El will try, but are not required, to communicate with me prior to such treatment.
Yes, I/we consent
Does your child have any emotional or behavioral needs of which we should be aware?
If yes: please describe the emotional or behavioral needs.
Does your child have any learning needs of which we should be aware?
If yes: does your child currently have an IEP or 504 plan?
If yes: please describe the learning needs.
Emergency Contact Information
Emergency Contact Name
Emergency Contact Email
Emergency Contact Cell Phone
Emergency Contact - Relationship to Child
Parent #1 - Name
Parent #2 - Name
Parent #1 - Email
Parent #2 - Email
Parent #1 - Cell Phone
Parent #2 - Cell Phone
Parent #1 - Home Phone
Parent #2 - Home Phone
Information regarding the Religious School and your child’s progress should be sent to
I consent to the use of photographs and/or videos taken of my child during the course of the school year for publicity, promotional, and or/educational purposes (including being posted on our private social media accounts.
Yes, I consent
No, I do not consent