Audrey Beth Lender Hebrew School Registration
2024-25/5785
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Email *
Parents' names and cell phone numbers
(Please list primary contact first)
 *
Student's Name - please feel free to include pronouns - https://pronouns.org/  *
Student's Grade as of 9/2024 *
Student's Birthday *
MM
/
DD
/
YYYY
Student's Hebrew Name 
Primary phone number for contact *
Student's Address/es *
Student's Primary School 
Family's Email Address/es (please list email addresses for all family members who wish to receive school-related information)  *
Tuition for Members AND Non-Members 
(families with students in 3rd or higher are asked to become members)

Saturdays 9:30 am - 11:30 am 
Wednesdays 4:30 pm - 6:30 pm 
 *
Required
EMERGENCY CONTACTS: Please list 3 additional contacts in the order you would like them called 
(name, cell number, and relationship to child)
 *
Medical - Please list all allergies, if your child carries an Epi Pen,  or has any other medical needs
Learning Goals - Please include IEP/504 (if relevant) and any other learning goals/needs for your student 
*All new students must have immunization records on file before school begins.  They can be dropped off to the main office or emailed to educationdirector@csinyack.org  
**All other students only need to provide new immunization records if they have been updated or changed since last year.
***Please indicate status of records in space below
Is there anything specific you would like us to know about your child? 
Photo Release
A detailed disclosure explanation will be included in the Hebrew School Handbook.  
*You may change your preference at any time.
 *
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