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) *
Your answer
Hebrew Name *
Your answer
Date of Birth *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Student’s email address
Your answer
Student ‘s cell phone number
Your answer
Parent/Guardian Name (1) *
Your answer
Parent/Guardian email (1) *
Your answer
Parent/Guardian cell phone number (1) *
Your answer
Parent/Guardian Name (2)
Your answer
Parent/Guardian email (2)
Your answer
Parent/Guardian cell phone number (2)
Your answer
Grade in Secular School September, 2019 *
Name of Secular School *
Your answer
What are the best methods of learning for your child?
Your answer
Is there anything else we should know about your child?
Your answer
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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