Pre-K Religious School Registration 2024-2025 - Form

PARENT INFORMATION

* Parent 1 First Name

* Parent 1 Last Name

* Parent 1 Email

* Parent 1 Cell

Parent 1 Hebrew Name

Are you Jewish?

JewishNot JewishIf you have questions about how to answer this question, Rabbi Rosin will be happy to discuss it with you. if you would like to speak with Rabbi Rosin please call the office at 631-427-1089 x 10 or at rabbirosin@hjcny.org.

Parent 2 First Name

Parent 2 Last Name

Parent 2 Email

Parent 2 Cell

Parent 2 Hebrew Name

Are you Jewish?

* Address 1 (Children)

Address 2 (Children)

* City (Children)

* State (Children)

* Zip (Children)

* Is either parent a member of Huntington Jewish Center?

Please Select OneYesNo

* How would you, as a parent/guardian, like to get involved. Please check at least one.

EMERGENCY CONTACT(S)

* How many emergency contacts would you like to add?

* Contact 1 Name

* Relationship to child(ren)

* Cell

CHILD(REN) INFORMATION

* Please select the number of children you are registering for pre-K religious school for the 2024-2025 school year?

* Student First Name

* Student Last Name

Gender

* Student Hebrew Name

* Student Date of Birth

* School District (or name of school if private)

Food Allergies/Intolerances

Other Allergies/Medical Conditions

* Does this child live at home with both parents?

* If not, please explain:

Does this child have an IEP/504 plan/special learning needs/medical condition we should be aware of? If so please specify here.

Is there a situation at home that might impact attendance and/or participation in religious school? If so please explain here.

* I give permission for this child's photo or likeness to appear in the Temple bulletin, local paper, or HJC social media pages:

* I give permission for school authorities to take any action deemed necessary if I cannot be reached by telephone in case of emergency.

Please note that if you have a child entering 3rd grade, your registration will not be complete unless you are a synagogue member. Synagogue membership is required for children in 3rd grade and up. Please contact Rachel Gritz, in the Main Office to fill out a membership application at rgritz@hjcny.org or at 631-427-1089 x 23.

Total to be paid now