Save the Date of our Hanukkah Dinner and festivities....Dec 15th! ECC and Religious School registration info & Membership application, see below. Calendar Donations + Payments Home About Us Leadership Contact Us Our Location Affiliations FAQ & Special Events Calendar Services Video Streaming Community Sisterhood Honey Sale Shalach Manot 2024 (Shalach Manot 2024 Order Form) Men's Club Youth PJ Library Empty Nesters Social Action Learning Early Childhood Center Religious School RS Registration 2024-25 RS Registration 2024-25 Short Form Registration for Hebrew High School 2024-25 >> ECC Admission Application 2024-2025 Lifelong Learning Resources Membership Application Hamvaser Liturgy & Trope Torah Cantillation (Trope) Worksheets Jr Congregation Shabbat Morning Prayers Memorial Plaques & Tree of Life Special Events & FAQ Calendar Donations + Payments RS Registration 2023-24 Please verify reCaptcha before submitting the form. Greenburgh Hebrew Center Religious School 515 Broadway Dobbs Ferry, NY 10522 914-693-4260 (main office) 914-479-1400 (school) www.ghcny.org Shara Sheinberg, VP of Education vpeducation@ghcny.org Registration Form For Religious School Gan - Zayin 2023-2024 If your child(ren) had attending RS last year, you may want to use the short form registration form * How many children are you registering for Religious School?Please Select OneOneTwoThreeIf you are registering more than 3 children, please call the synagogue office at 914-693-4260 First Child:* Name of First Child* First Child - Date of Birth* Child's Pronoun:Please Select OneHe/Him/HisShe/Her/HersThey/Their/TheirsOtherFirst child - Please enter your child's Hebrew name (if known):* First Child - What Grade will your child be in the fall?Please Select OneGan (Kindergarten)Aleph (1st Grade)Bet (2nd Grade)Gimmel (3rd Grade)Dalet (4th Grade)Hay (5th Grade)Vav (6th Grade)Zayin (7th Grade)See end of form for tuition rates Use of Images in the Media* Media ConsentPlease Select OneYes, 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: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 TreatmentPART I: Yes, I give my consent for emergency medical treatment of my child as outlined below:PART I: Yes, I give my consent for emergency medical treatment of my child as outlined below: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. Parent/Legal Guardian Name: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 TreatmentPART II: NO, I do NOT give my consent for emergency medical treatment of my child.PART II: NO, I do NOT give my consent for emergency medical treatment of my child.Parent/Legal Guardian Name: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 for the first child:* Parent/Guardian 1: First Name* Parent/Guardian 1: Last Name* Relationship of Parent/Guardian 1 to the child:* Street Address of Parent/Guardian 1Additional address info * State--Select State--AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming* Zip* Email address for Parent/Guardian 1:* Home phone for Parent/Guardian 1:Cell phone for Parent/Guardian 1:* Which is the best phone number to contact Parent/Guardian 1?Please Select OneHome phoneCell phoneParent/Guardian 2: First NameParent/Guardian 2: Last NameRelationship of Parent/Guardian 2 to the child:Street Address of Parent/Guardian 2Email address for Parent/Guardian 2:Home phone for Parent/Guardian 2:Cell phone for Parent/Guardian 2:Which is the best phone number to contact Parent/Guardian 2?Please Select OneHome phoneCell phone Additional Information about the first child:* Does this child have an IEP, 504 Plan, or other academic plan in place in their secular school?Please Select OneYesNoIf yes, please provide information on your child's academic plan:* Is there anything we need to know or be sensitive to concerning the emotional or behavioral well-being of this child?Please Select OneYesNoIf yes, please provide information on your child's emotional or behavioral well-being.* Does this child have any food allergies?Please Select OneYesNoif 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.* Does this child have any other health concerns that could affect them at Religious School?Please Select OneYesNoIf 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: Emergency Contact Information for the first child:First Child - Name of child's Primary PhysicianFirst Child - Phone number of child's Primary PhysicianFirst Child - Name of child's DentistFirst Child - Phone number of child's Dentist* First Child - Emergency Contact 1Please enter the name of an emergency contact who is not a Parent/Guardian of the child.* First Child - Relationship to Emergency Contact 1For example: Aunt, Uncle, Cousin, or friend* First Child - Emergency Contact 1 Phone NumberFirst Child - Emergency Contact 2Please enter the name of an emergency contact who is not a Parent/Guardian of the child.First Child - Relationship to Emergency Contact 2For example: Aunt, Uncle, Cousin, or friendFirst Child - Emergency Contact 2 Phone Number Second Child:Second Child - NameSecond child - Date of BirthChild's Pronoun:Please Select OneHe/Him/HisShe/Her/HersThey/Their/TheirsOtherSecond child - Please enter your child's Hebrew name (if known):Second child = What grade will your child be in the fall?Please select one:Gan (Kindergarten)Aleph (1st Grade)Bet (2nd Grade)Gimmel (3rd Grade)Dalet (4th Grade)Hay )5th Grade)Vav (6th Grade)Zayin (7th Grade)See end of form for sibling discount information Use of Images in the Media - Second Child Media ConsentPlease Select OneYes 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 wave 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:Please enter the name of the parent or legal guardian who completed the "Use of Images in the Media" form for the 2nd child. Consent for Emergency Medical Treatment for the Second Child 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:PART I: Yes, I give my consent for emergency medical treatment of my child as outlined below: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. Parent/Legal Guardian Name:Please enter the name of the parent or legal guardian who completed Part I - Consent for Emergency Medical Treatment for the 2nd child. PART II - Consent is NOT given for Emergency Medical TreatmentPART II: NO, I do NOT give my consent for emergency medical treatment of my child.PART II: NO, I do NOT give my consent for emergency medical treatment of my child.Parent/Legal Guardian Name:Please enter the name of the parent or legal guardian who completed Part II - Consent is not given for emergency medical treatment of the 2nd child. Parent/Guardian Information for the second child:* Are the Parents/Guardians of the second child the same as for the first child?Please Select OneYesNo* Second Child - Parent/Guardian 1: First Name* Second Child - Parent/Guardian 1: Last Name* Second Child - Relationship of Parent/Guardian 1 to the child:* Second Child - Street Address of Parent/Guardian 1Second Child - Email address for Parent/Guardian 1:Second Child - Home phone for Parent/Guardian 1:Second Child - Cell phone for Parent/Guardian 1:Second Child - Which is the best phone number to contact Parent/Guardian 1?Please Select OneHome phoneCell phoneSecond Child - Parent/Guardian 2: First NameSecond Child - Parent/Guardian 2: Last NameSecond Child - Relationship of Parent/Guardian 2 to the child:Second Child - Street Address of Parent/Guardian 2Second Child - Email address for Parent/Guardian 2:Second Child - Home phone for Parent/Guardian 2:Second Child - Cell phone for Parent/Guardian 2:Second Child - Which is the best phone number to contact Parent/Guardian 2?Please Select OneHome phoneCell phone Additional Information about the second child:* Does your 2nd child have an IEP, 504 Plan, or other academic plan in place in their secular school?Please Select OneYesNo* If yes, please provide information on your 2nd child's academic plan:* Is there anything we need to know or be sensitive to concerning the emotional or behavioral well-being of this child?Please Select OneYesNoIf yes, please provide information on your 2nd child's emotional or behavioral well-being.* Does your 2nd child have any food allergies?Please Select OneYesNoif yes, please provide specific information on your 2nd 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 Educaton in a plastic zip-lock bag.* Does your 2nd child have any other health concerns that could affect them at Religious School?Please Select OneYesNoIf yes, please provide specific information on your 2nd 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 2nd child: Emergency Contact Information for the second child:* Is ALL of the Emergency Contact information for the second child the same as for the first child?Please Select OneYesNoThis includes: Primary Physician, Dentist, and 2 non-parent/guardian emergency contacts.Second Child - Name of child's Primary PhysicianSecond Child - Phone number of child's Primary PhysicianSecond Child - Name of child's DentistSecond Child - Phone number of child's DentistSecond Child - Emergency Contact 1Please enter the name of an emergency contact who is not a Parent/Guardian of the child.Second Child - Relationship to Emergency Contact 1For example: Aunt, Uncle, Cousin, or friendSecond Child - Emergency Contact 1 Phone NumberSecond Child - Emergency Contact 2Please enter the name of an emergency contact who is not a Parent/Guardian of the child.Second Child - Relationship to Emergency Contact 2For example: Aunt, Uncle, Cousin, or friendSecond Child - Emergency Contact 2 Phone Number Third Child:Third Child - NameThird Child - Date of BirthChild's PronounPlease Select OneHe/Him/HisShe/Her/HersThey/Their/TheirsOtherThird Child - Please enter your child's Hebrew name (if known):Third Child - What grade will your child be in the fallPlease select oneGan (Kindergarten)Aleph (1st Grade)Bet (2nd Grade)Gimmel (3rd Grade)Dalet (4th Grade)Hay (5th Grade)Vav (6th Grade)Zayin (7th Grade) Use of Images in the Media - Third Child Media ConsentPlease Select OneYes 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 wave 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:Please enter the name of the parent or legal guardian who completed the "use of Imges in the Media" form for the 3rd child. Consent for Emergency Medical Treatment for the Third Child 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:PART I: Yes, I give my consent for emergency medical treatment of my child as outlined below: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. Parent/Legal Guardian Name:Please enter the name of the parent or legal guardian who completed Part 1 - Consent for Emergency Medical Treatment for the 3rd child. Part II - Consent is NOT given for Emergency Medical Treatment Part II: No, I do NOT give my consent for emergency medical treatment of my child.Part II: No, I do NOT give my consent for emergency medical treatment of my child.Parent/Legal Guardian Name:Please enter the name of the parent or legal guardian who completed Part II - Consent is not given for emergency medical treatment of the 3rd child. Parent/Guardian Information for the third child:* Are the Parents/Guardians of the third child the same as for the first or second child?Please Select OneYesNo* Please choose from below:Please Select OneParents/Guardians are the same as the First ChildParents/Guardians are the same as the Second Child* Third Child - Parent/Guardian 1: First Name* Third Child - Parent/Guardian 1: Last Name* Third Child - Relationship of Parent/Guardian 1 to the child:* Third Child - Street Address of Parent/Guardian 1Third Child - Email address for Parent/Guardian 1:Third Child - Home phone for Parent/Guardian 1:Third Child - Cell phone for Parent/Guardian 1:Third Child - Which is the best phone number to contact Parent/Guardian 1?Please Select OneHome phoneCell phoneThird Child - Parent/Guardian 2: First NameThird Child - Parent/Guardian 2: Last Name* Third Child - Relationship of Parent/Guardian 2 to the child:Third Child - Street Address of Parent/Guardian 2Third Child - Email address for Parent/Guardian 2:Third Child - Home phone for Parent/Guardian 2:Third Child - Cell phone for Parent/Guardian 2:Third Child - Which is the best phone number to contact Parent/Guardian 2?Please Select OneHome phoneCell phone Additional Information about the third child:* Does your 3rd child have an IEP, 504 Plan, or other academic plan in place in their secular school?Please Select OneYesNo* If yes, please provide information on your 3rd child's academic plan:* Is there anything we need to know or be sensitive to concerning the emotional or behavioral well-being of this child?Please Select OneYesNoIf yes, please provide information on your 3rd child's emotional or behavioral well-being.* Does your 3rd child have any food allergies?Please Select OneYesNoif yes, please provide specific information on your 3rd 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.* Does your 3rd child have any other health concerns that could affect them at Religious School?Please Select OneYesNoIf yes, please provide specific information on your 3rd 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 3rd child: Emergency Contact Information for the third child:* Is ALL of the Emergency Contact information for the third child the same as for the first or second child?Please Select OneYesNoOnly choose "Yes" if ALL of the information (Primary Physician, Dentist, and both Emergency Contacts) are exactly the same.* Please choose from below:Please Select Oneemergency Contact Information is the same as the First ChildEmergency Contact Information is the same as the Second ChildThird Child - Name of child's Primary PhysicianThird Child - Phone number of child's Primary PhysicianThird Child - Name of child's DentistThird Child - Phone number of child's DentistThird Child - Emergency Contact 1Please enter the name of an emergency contact who is not a Parent/Guardian of the child.Third Child - Relationship to Emergency Contact 1For example: Aunt, Uncle, Cousin, or friendThird Child - Emergency Contact 1 Phone NumberThird Child - Emergency Contact 2Please enter the name of an emergency contact who is not a Parent/Guardian of the child.Third Child - Relationship to Emergency Contact 2For example: Aunt, Uncle, Cousin, or friendThird Child - Emergency Contact 2 Phone Number Please list all other children in your family NOT listed above:Other Children - NameOther Children - Date of BirthChild's PronounPlease Select OneHe/Him/HisShe/Her/HersThey/Their/TheirsOtherOther Children - NameOther Children - Date of BirthChild's PronounPlease Select OneHe/Him/HisShe/Her/HersThey/Their/TheirsOther EARLY BIRD TUITION RATES (First payment & registration form must be received by June 30th, second Payment must be received by September 1.) Member of GHC Gan...............Aleph................Bet..........Gimmel.........Dalet........Hay..........Vav.........Zayin. Total $0.00 $500.00 $850.00 >>>>>>>>>>>>>$1650.00<<<<<<<<<<<<< 1st payment by 6/30/23 $250.00 $425.00 >>>>>>>>>>>>> $ 825.00<<<<<<<<<<<<< 2nd payment by 9/1/23 $250.00 $425.00 >>>>>>>>>>>>> $ 825.00<<<<<<<<<<<<< Non-Member of GHC Same as above but only applies to Gan through Bet. Gimmel and higher must be a member of GHC One sibling discount of $100 per family. Children need to be registered in grades Gimmel thru Zayin REGULAR TUITION Member of GHC Gan...............Aleph................Bet..........Gimmel.........Dalet........Hay..........Vav.........Zayin. Total $0.00 $600.00 $950.00 >>>>>>>>>>>>>$1750.00<<<<<<<<<<<<< 1st payment by 8/1//23 $300.00 $475.00 >>>>>>>>>>>>> $ 875.00<<<<<<<<<<<<< 2nd payment by 12/1/23 $300.00 $475.00 >>>>>>>>>>>>> $ 875.00<<<<<<<<<<<<< Non-Member of GHC Same as above but only applies to Gan through Bet. Gimmel and higher must be a member of GHC One sibling discount of $100 per family. Children need to be registered in grades Gimmel thru Zayin * Total Number Enrolled in GHC Religious School* PTA Membership Dues at $36.00 per childTotal PTA dues Tuition Payment* Total for all children:The above amount is the TOTAL for Religious School Tuition for ALL children registered, inclusive of PTA dues. If more than one, please apply the $100.00 sibling discount to the total due. Only one sibling discount is allowed per family. Students must be in grades Gimmel thru Zayin.* PaymentPlease Select OneI will pay by credit card. Please go to the payment section on the home page of our website.I will pay by check and send it to the GHC office. Check made out to Greenburgh Hebrew CenterPlease charge my accountTHANK YOU!! Your payment is greatly appreciated. Any issues, please contact the office or the Director of Education Member referralThank you for completing your reqistration. If your child(ren) are registering for the first time in our Religious School and this is your first school association with GHC, please advise how you heard of GHC. If you were referred by a person(s) currently associated with GHC, please indicate their name as well. Wed, December 4 2024 3 Kislev 5785
Please verify reCaptcha before submitting the form.
Greenburgh Hebrew Center Use of Images in the Media:
Please enter the name of the parent or legal guardian who completed the "Use of Images in the Media" form:
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
Please enter the name of the parent or legal guardian who completed Part II - Consent is not given for emergency medical treatment.
Use of Images in the Media - Second Child
Please enter the name of the parent or legal guardian who completed the "Use of Images in the Media" form for the 2nd child.
Consent for Emergency Medical Treatment for the Second Child PART I OR II MUST BE COMPLETED BELOW:
PART I - Providing Consent for Emergency Medical Treatment
Please enter the name of the parent or legal guardian who completed Part I - Consent for Emergency Medical Treatment for the 2nd child.
Please enter the name of the parent or legal guardian who completed Part II - Consent is not given for emergency medical treatment of the 2nd child.
Use of Images in the Media - Third Child
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 wave 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 Imges in the Media" form for the 3rd child.
Consent for Emergency Medical Treatment for the Third Child PART I OR II MUST BE COMPLETED BELOW:
Please enter the name of the parent or legal guardian who completed Part 1 - Consent for Emergency Medical Treatment for the 3rd child.
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 of the 3rd child.
