The Emanuel Synagogue Religious School Registration Form 2019-20 5779-80
Please note: Pre-K- Grade 2 is held on Sundays from 9:00-12:00.

Grades 3-7 are held on Wednesdays from 4:00-6:00 pm and Sundays from 9:00-12:00.
Untitled Title
Child’s Name (first and last) *
Hebrew Name *
Date of Birth *
Address *
City *
State *
Zip Code *
Student’s email address
Student ‘s cell phone number
Parent/Guardian Name (1) *
Parent/Guardian email (1) *
Parent/Guardian cell phone number (1) *
Parent/Guardian Name (2)
Parent/Guardian email (2)
Parent/Guardian cell phone number (2)
Grade in Secular School September, 2019 *
Name of Secular School *
What are the best methods of learning for your child?
Is there anything else we should know about your child?
Does your child have an IEP or 504 Plan? *
Does your child have an aide or para-professional in secular school? *
Does your child have trouble with social interactions? *
Does your child have a behavior modification system they use in secular school? *
Is your child on any medication(s) that may affect their behavior? *
From time to time we take pictures of students to be used for promotional purposes. Photos might be used (but not limited to) on our TV in the school, our website, Facebook, our newsletter etc. *
Required
Please include our family's information in a school directory to be distributed to other families *
Thank you for registering! If you have any other questions or concerns you can write them below, call 860-233-2774 or email school@emanuelsynagogue.org
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