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RELIGIOUS SCHOOL REGISTRATION

 

Please note....it is EXTREMELY important if you are a current member of GHC or not yet a member but associated with GHC in some way (ex. child was in the  ECC), that you log into your account BEFORE completing this registration.  If you don't know yet how to do that, please go to the log in page (home page), use your email address that GHC has on file and select forgot password.  You will then be requested to establish a password for your account. If you have not been associated with GHC in any way, please contact the office so they can establish your online account.  

Once you fill in the first question, the form will guide you the rest of the way.

 

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 Religious School
Gan  - Zayin
If you are registering more than 3 children, please call the synagogue office at 914-693-4260

First Child:
See end of form for tuition rates

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 for the first child:

Additional Information about the first 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

Second Child:
See end of form for sibling discount information

Use of Images in the Media - Second 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 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

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 for the 2nd 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 2nd child.


Parent/Guardian Information for the second child:

Additional Information about the second 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 Educaton 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 second child:
This includes: Primary Physician, Dentist, and 2 non-parent/guardian emergency contacts.
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

Third 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:

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 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.


Parent/Guardian Information for the third child:

Additional Information about the third 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 third child:
Only choose "Yes" if ALL of the information (Primary Physician, Dentist, and both Emergency Contacts) are exactly the same.
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 NOT listed above:
EARLY BIRD TUITION RATES
Member of GHC
                    Gan...............Aleph................Bet..........Gimmel.........Dalet........Hay..........Vav.........Zayin.
Total             $0.00            $500.00            $850.00    >>>>>>>>>>>>>$1650.00<<<<<<<<<<<<<

1st payment by 6/30/21   $250.00            $425.00    >>>>>>>>>>>>> $ 825.00<<<<<<<<<<<<<
2nd payment by 9/1/21    $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//21    $300.00            $475.00    >>>>>>>>>>>>> $ 875.00<<<<<<<<<<<<<
2nd payment by 12/1/21   $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:
Total PTA dues
Tuition Payment
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.

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

 

Sun, November 28 2021 24 Kislev 5782