Greenburgh Hebrew Center Religious School
515 Broadway
Dobbs Ferry, NY 10522
914-693-4260 (main office)
914-479-1400 (school)
www.ghcny.org
Marcia Lane, Religious School Principal
rsprincipal@ghcny.org
Registration Form For Hebrew High School
2023-2024
(Please note...if you are a member of GHC, please make sure you complete this form by first logging into your GHC account. Any issues, please contact the office at office@ghcny.org...Thank you!)
Use of Images in the Media
Please Select One Yes, I do hereby consent and agree with the statement below and allow the use of images of myself or my child in the media. No, I do not consent to the use of images of myself or my child in the media.
Greenburgh Hebrew Center Use of Images in the Media:
Greenburgh Hebrew Center, its employees, or agents have the right to take photographs, videotape, or digital recordings ("Images") of me or my child and to use these in any and all media exclusively for the purpose of communicating the educational activities of the synagogue. I do hereby release to Greenburgh Hebrew Center, its agents, and employees all rights to exhibit this work in print and electronic form publicly or privately. I waIve any rights, claims, or interest I may have to control the use of my image in whatever media used. Child last names will not be used with media images. * Parent/Legal Guardian Name:
Consent for Emergency Medical Treatment
PART I OR II MUST BE COMPLETED BELOW:
PART I - Providing Consent for Emergency Medical Treatment
PART I: Yes, I give my consent for emergency medical treatment of my child as outlined below: Parent/Legal Guardian Name:
PART II - Consent is NOT given for Emergency Medical Treatment
Parent/Legal Guardian Name:
Parent/Guardian Information:
Additional Information about the child:
If yes, please provide information on your child's academic plan:
If yes, please provide information on your child's emotional or behavioral well-being.
If yes, please provide specific information on your child's food allergies: If your child has a food allergy, we require that an unopened EpiPen pack along with instructions and contact phone numbers be provided to the Director of Education in a plastic zip-lock bag.
If yes, please provide specific information on your child's health concerns. If there is a chance that your child will need medication, such as an inhaler for asthma, during school hours, please provide the Director of Education with an unopened package of the medication, instructions and contact phone numbers in a plastic zip-lock bag.
Please share any other information that will help us create a safe, effective, and meaningful educational experience for your child:
Previous Religious School Training, if any, if your child did not attend GHC's Religious School:
Emergency Contact Information for the first child:
Please list all other children in your family:
Hebrew High School Tuition for this school year: $500.00
Tuition Payment