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Registration for Hebrew High School

Greenburgh Hebrew Center Religious School
515 Broadway
Dobbs Ferry, NY 10522
914-693-4260 (main office)
914-479-1400 (school)
www.ghcny.org 
Amy Kessler, Director of Education
directored@ghcny.org
Registration Form For Hebrew High School

(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


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.

Please enter the name of the parent or legal guardian who completed the "Use of Images in the Media" form:


Consent for Emergency Medical Treatment
PART I OR II MUST BE COMPLETED BELOW:
PART I - Providing Consent for Emergency Medical Treatment

IF REASONABLE ATTEMPTS TO REACH ME FAIL, I HEREBY GIVE MY CONSENT FOR:
1. The administration of any treatment deemed necessary by the medical professionals I have listed as my child's physician in the "emergency contacts" section of this enrollment form.
2. If my designated medical professional is not available, by another medical professional; and
3. The transfer of my child to any hospital reasonably accessible.  

Please enter the name of the parent or legal guardian who completed Part I - Consent for Emergency Medical Treatment

PART II - Consent is NOT given for Emergency Medical Treatment

Please enter the name of the parent or legal guardian who completed Part II - Consent is not given for emergency medical treatment.


Parent/Guardian Information:
If same as Parent/Guardian 1 just write "same"

Additional Information about the child:
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 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.

Emergency Contact Information for the first child:
Please enter the name of an emergency contact who is not a Parent/Guardian of the child.
For example:  Aunt, Uncle, Cousin, or friend
Please enter the name of an emergency contact who is not a Parent/Guardian of the child.
For example:  Aunt, Uncle, Cousin, or friend

Please list all other children in your family:
Hebrew High School Tuition for this school year:    $500.00
Tuition Payment

THANK YOU!!  Your payment is greatly appreciated.
Any issues, please contact the office or the Director of Education

By clicking submit below, you agree to have your child follow all protocols and proceedures instituted by Greenburgh Hebrew Center.   Thank you!
Sun, November 28 2021 24 Kislev 5782