The Emanuel Synagogue Religious School Registration Form 2018-19 5779
Please note: Pre-K- Grade 2 is held on Sundays from 9:00-12:00.

NEW THIS YEAR!!! Grades 3-7 are held on Wednesdays from 4:00-6:00 pm and Sundays from 9:00-12:00.

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 September, 2018 *
Name of Secular School *
Your answer
Is your child receiving special education services in secular school? *
If yes, please explain what kind of services your child receives so that we can best accommodate your child's needs
Your answer
Is there anything else we should know about your child?
Your answer
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! You will receive a bill based on your answers above. If you have any other questions or concerns you can write them below or call 860-233-2774 or email school@emanuelsynagogue.org
Your answer
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