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
Hazzan Marcia Lane, Principal
rsprincipal@ghcny.org
Registration Form For Religious School
Gan - Zayin
2024-25
If your child(ren) had attending RS last year, you may want to use the short form registration form
First Child:
Use of Images in the Media
* Media Consent 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 for the first child:
* State--Select State-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Street Address of Parent/Guardian 2
Additional Information about the first 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:
Emergency Contact Information for the first child:
Second Child:
Use of Images in the Media - Second Child
Parent/Legal Guardian Name:
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: Parent/Legal Guardian Name:
PART II - Consent is NOT given for Emergency Medical Treatment
Parent/Legal Guardian Name:
Parent/Guardian Information for the second child:
* Second Child - Street Address of Parent/Guardian 1
Second Child - Street Address of Parent/Guardian 2
Additional Information about the second child:
* If yes, please provide information on your 2nd child's academic plan:
If yes, please provide information on your 2nd child's emotional or behavioral well-being.
if 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.
If 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:
Third Child:
Parent/Legal Guardian Name:
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: Parent/Legal Guardian Name:
Part II - Consent is NOT given for Emergency Medical Treatment
Parent/Legal Guardian Name:
Parent/Guardian Information for the third child:
* Third Child - Street Address of Parent/Guardian 1
Third Child - Street Address of Parent/Guardian 2
Additional Information about the third child:
* If yes, please provide information on your 3rd child's academic plan:
If yes, please provide information on your 3rd child's emotional or behavioral well-being.
if 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.
If 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:
Please list all other children in your family NOT listed above:
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
Tuition Payment