RS Registration 2025-26 Short Form - Form

Attend "A Taste of Gan" Sunday, April 27 at noon. RSVP: RSDirector@ghcny.org. Register now for the 2025-26 ECC School Year and June Mini-Camp: See Below. Attend the May 18 Gala!

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RS Registration 2025-26 Short Form

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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

Short Form Registration For Religious School
Aleph - Zayin
2025-26
To be used for children who attended GHC RS last year -
Please note: There are some questions that we still need answered every year. The ones that are optional will state "if different from last year".

If you are registering your child for the first time, you need to use the regular long 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/TheirsOther
First 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 Consent
Please 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 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

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.

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 1
If different than last year
Additional address info
State
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 phone
Parent/Guardian 2: First Name
Parent/Guardian 2: Last Name
Relationship of Parent/Guardian 2 to the child:
Email 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 OneYesNo
If yes, please provide information on your child's academic plan: If SAME as last year, please indicate such.
* Is there anything we need to know or be sensitive to concerning the emotional or behavioral well-being of this child?
Please Select OneYesNo
If yes, please provide information on your child's emotional or behavioral well-being. If SAME as last year, please indicate as such.
* Does this child have any food allergies?
Please Select OneYesNo
If yes, please provide specific information on your child's food allergies: If SAME as last year, indicate as such.
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 OneYesNo
If yes, please provide specific information on your child's health concerns. If SAME as last year, please indicate as such.
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 or anything that has changed in the past year,.
If you would like to discuss this confidentially with Director Amy Kessler, please contact her.

Emergency Contact Information for the first child:
First Child - Name of child's Primary Physician
If different from last year.
First Child - Phone number of child's Primary Physician
If different from last year.
First Child - Name of child's Dentist
If different from last year.
First Child - Phone number of child's Dentist
If different from last year.
* First Child - Emergency Contact 1
Please enter the name of an emergency contact who is not a Parent/Guardian of the child. IF different from last year.
* First Child - Relationship to Emergency Contact 1
For example: Aunt, Uncle, Cousin, or friend
* First Child - Emergency Contact 1 Phone Number
If different from last year
First Child - Emergency Contact 2
Please enter the name of an emergency contact who is not a Parent/Guardian of the child.
If different from last year.
First Child - Relationship to Emergency Contact 2
For example: Aunt, Uncle, Cousin, or friend
First Child - Emergency Contact 2 Phone Number
If different from last year.

Second Child:
Second Child - Name
Second child - Date of Birth
Child's Pronoun:
Please Select OneHe/Him/HisShe/Her/HersThey/Their/TheirsOther
Second 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 Consent
Please 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 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 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 - 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 phone
Second Child - Parent/Guardian 2: First Name
Second Child - Parent/Guardian 2: Last Name
Second Child - Relationship of Parent/Guardian 2 to the child:
Second 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. If SAME as last year, please indicate as such
* Is there anything we need to know or be sensitive to concerning the emotional or behavioral well-being of this child?
Please Select OneYesNo
If yes, please provide information on your 2nd child's emotional or behavioral well-being. If SAME as last year, please indicate as such
* Does your 2nd child have any food allergies?
Please Select OneYesNo
if yes, please provide specific information on your 2nd child's food allergies. If SAME as last year, please indicate as such
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 OneYesNo
If yes, please provide specific information on your 2nd child's health concerns. If SAME as last year, please indicate as such
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:
If you wish to discuss this confidentially with our Director Amy Kessler, please contact her

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 Physician
Second Child - Phone number of child's Primary Physician
Second Child - Name of child's Dentist
Second Child - Phone number of child's Dentist
Second Child - Emergency Contact 1
Please enter the name of an emergency contact who is not a Parent/Guardian of the child.
Second Child - Relationship to Emergency Contact 1
For example: Aunt, Uncle, Cousin, or friend
Second Child - Emergency Contact 1 Phone Number
Second Child - Emergency Contact 2
Please enter the name of an emergency contact who is not a Parent/Guardian of the child.
Second Child - Relationship to Emergency Contact 2
For example: Aunt, Uncle, Cousin, or friend
Second Child - Emergency Contact 2 Phone Number

Third Child:
Third Child - Name
Third Child - Date of Birth
Child's Pronoun
Please Select OneHe/Him/HisShe/Her/HersThey/Their/TheirsOther
Third Child - Please enter your child's Hebrew name (if known):
Third 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)

Use of Images in the Media - Third Child

Media Consent
Please 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 - 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 phone
Third Child - Parent/Guardian 2: First Name
Third Child - Parent/Guardian 2: Last Name
* Third Child - Relationship of Parent/Guardian 2 to the child:
Third 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. If SAME as last year, please indicate as such
* Is there anything we need to know or be sensitive to concerning the emotional or behavioral well-being of this child?
Please Select OneYesNo
If yes, please provide information on your 3rd child's emotional or behavioral well-being. If SAME as last year, please indicate as such
* Does your 3rd child have any food allergies?
Please Select OneYesNo
if yes, please provide specific information on your 3rd child's food allergies: If SAME as last year, please indicate as such
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 OneYesNo
If yes, please provide specific information on your 3rd child's health concerns. If SAME as last year, please indicate as such
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:
If you would like to discuss this confidentially with our Director Amy Kessler, please contact her.

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 Child
Third Child - Name of child's Primary Physician
Third Child - Phone number of child's Primary Physician
Third Child - Name of child's Dentist
Third Child - Phone number of child's Dentist
Third Child - Emergency Contact 1
Please enter the name of an emergency contact who is not a Parent/Guardian of the child.
Third Child - Relationship to Emergency Contact 1
For example: Aunt, Uncle, Cousin, or friend
Third Child - Emergency Contact 1 Phone Number
Third Child - Emergency Contact 2
Please enter the name of an emergency contact who is not a Parent/Guardian of the child.
Third Child - Relationship to Emergency Contact 2
For example: Aunt, Uncle, Cousin, or friend
Third Child - Emergency Contact 2 Phone Number

Please list all other children in your family NOT listed above:
Other Children - Name
Other Children - Date of Birth
Child's Pronoun
Please Select OneHe/Him/HisShe/Her/HersThey/Their/TheirsOther
Other Children - Name
Other Children - Date of Birth
Child's Pronoun
Please 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 $600.00 $950.00 >>>>>>>>>>>>>$1750.00<<<<<<<<<<<<<

1st payment by 6/30/25   $300.00   $475.00 >>>>>>>>>>>>> $ 875.00<<<<<<<<<<<<<
2nd payment by 9/1/25 $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

REGULAR TUITION

Member of GHC
Gan...............Aleph................Bet..........Gimmel.........Dalet........Hay..........Vav.........Zayin.
Total $0.00 $700.00 $1050.00 >>>>>>>>>>>>>$1850.00<<<<<<<<<<<<<

1st payment by  8/1//25 $350.00    $525.00 >>>>>>>>>>>>> $ 925.00<<<<<<<<<<<<<
2nd payment by 12/1/25 $350.00   $525.00 >>>>>>>>>>>>> $ 925.00<<<<<<<<<<<<<

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 child
Total 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.
* Payment
Please 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 account
THANK YOU!! Your payment is greatly appreciated.
Any issues, please contact the office or the Director of Education
Member referral
Thank 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.

Fri, April 25 2025 27 Nisan 5785

Greenburgh Hebrew Center
515 Broadway
Dobbs Ferry, NY 10522
(914) 693-4260

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