Leonard & Barbara Zimet Religious School

2019/2020 REGISTRATION

Register for the 2019/2020 School Year Today

Registration is now open!

Please submit your registration using the form below. Alternatively, you can click here to print out the registration form and return it to the office in person or via mail:

Congregation Emanuel of the Hudson Valley

243 Albany Ave

Kingston, NY 12401

We are committed to working with each child and family to help each student find a home with us, regardless of finances or other challenging circumstances. Please do not hesitate to contact our Religious School Director Samara Gilman at templeemanuelrsd@gmail.com to set-up a phone call, in-person meeting, or tour of our school.

Religious School Registration 2019–2020

Student #1*
First Last
Student #1 Date of Birth*
Date Format: MM slash DD slash YYYY
#1 Hebrew Name (In English or Hebrew)
If possible. If you would like to learn more about Hebrew names, please indicate here
#1 Secular Grade Level in the 2019-2020 School Year*
#1 Other (Secular Grade Level) (please specify)
#1 Tee Shirt Size*
#1 Is the student provided any special services in secular school? If yes, please provide detail. We are committed to ensuring our environment is inclusive.
#1 Is there any other information we should be aware of that would help us to create the most favorable learning experience for the student?
#1 Allergies*
#1 Medications
#1 Primary Care Provider Name*
#1 Primary Care Provider Phone*
#1 Other pertinent medical information
Are you enrolling a second student?*
Student #2
Student #2
If you are enrolling a second child, please include their name here.
First Last
Student #2 Date of Birth
Date Format: MM slash DD slash YYYY
#2 Hebrew Name (In English or Hebrew)
If possible. If you would like to learn more about Hebrew names, please note on this form
#2 Secular Grade Level in the 2019-2020 School Year
#2 Other (Secular Grade Level) (please specify)
#2 Tee Shirt Size
#2 Is the student provided any special services in secular school? If yes, please provide detail. We are committed to ensuring our environment is inclusive.
#2 Is there any other information we should be aware of that would help us to create the most favorable learning experience for the student?
#2 Allergies*
#2 Medications
#2 Primary Care Provider Name
If different from sibling #1
#2 Primary Care Provider Phone
If different from sibling #1
#2 Other pertinent medical information
Are you enrolling a third student?
Student #3
Student #3
First Last
Student #3 Date of Birth
Date Format: MM slash DD slash YYYY
#3 Hebrew Name (In English or Hebrew)
If possible. If you would like to learn more about Hebrew names, please note on this form
#3 Secular Grade in the 2019-2020 School Year
#3 Other (Secular Grade Level) (please specify)
#3 Tee Shirt Size
#3 Is the student provided any special services in secular school? If yes, please provide detail. We are committed to ensuring our environment is inclusive.
#3 Is there any other information we should be aware of that would help us to create the most favorable learning experience for the student?
#3 Allergies
#3 Medications
#3 Primary Care Provider Name
If different from siblings #1 & #2
#3 Primary Care Provider Phone
If different from siblings #1 & #2
#3 Other pertinent medical information
Do you need to enroll additional students?
Please indicate here- we will be in contact shortly!
(A) Parent/Guardian
Parent/Guardian (A)*
First Last Suffix
Cell Phone (A)*
Home Phone (A)*
If not available, please type in zeros
Email (A)*
Home or Mailing Address: Parent (A)*
Street Address Address Line 2 City State ZIP Code
(B) Parent/Guardian
Parent/Guardian (B)
Prefix First Last
Cell Phone (B)
Home Phone (B)
If Different than Home Phone (A)
Email (B)
Home or Mailing Address: Parent (B)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Primary Residence of Child(ren)*
Primary Emergency Contact #1
Primary Emergency Contact #1*
First Last
Relationship to Child- Primary Emergency Contact #1*
Phone- Primary Emergency Contact #1*
Primary Emergency Contact #2
Primary Emergency Contact #2*
First Last
Relationship to Child- Primary Emergency Contact #2*
Phone- Primary Emergency Contact #2*
Photo Release
Pictures are often taken during temple programs. We would like your permission to use these photos on our website (CEHV.org), in our bulletin, and occasionally on flyers and ads or other promotional items. Pictures are selected for Congregation Emanuel to use to illustrate our holidays, special programs and Religious School program. The use will be for sharing with our community the joyous, fun and engaging experience our youth have during our events at Congregation Emanuel. Images will not be identified with the name of your child(ren).

Please note, that if you do not release the right for Zimet Religious School to use your child(ren)’s likeness, then we may at times need to take group photos that will not have your child in them.

*Please note you may rescind your release at any time by submitting a written request to the main office.
*
- YES, I give permission to include photos of my child(ren) on Congregation Emanuel of the Hudson Valley’s website, bulletin, flyers and ads, or other promotional items.
- NO, I DO NOT give permission to include photos of my child(ren).
Signature*
Please type your full name, including middle name/initial to securely sign the Photo Release section of the form.
First Middle Last
Signature
Tuition
~ CURRENT CONGREGATION EMANUEL MEMBERSHIP IS A REGISTRATION PREREQUISITE ~
If your family needs financial assistance, please contact our Confidential Dues Committee at (845) 338-4271 x128.

Please make any alternate financial arrangements no later than 30 days before the first day of school. Please contact Regina in the main office at 845.338.4271.
Price
Total Tuition Prices are for the entire year and include book & material fees

Pre-K (1/2 day): $230

Kindergarten (1/2 day): $330

Grades 1 & 2: $395

Grades 3-8: $695

Grades 9-12: $350

Please enter the total payment you will be making today. We encourage you to pay what you can today, with a minimum $50 down payment. If you will be paying with a check or ash, please enter $0.00 in the field below.
Payment Options*
A down payment of $50 is due at the time of registration
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Billing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Name
Please enter your name as it appears on your credit card
First Middle Last
Name
This field is for validation purposes and should be left unchanged.

This iframe contains the logic required to handle Ajax powered Gravity Forms.

Leonard & Barbara Zimet Religious School

2019/2020 REGISTRATION

Register for the 2019/2020 School Year Today

Religious School Registration 2019–2020

Student #2

Student #3

(A) Parent/Guardian

(B) Parent/Guardian

Primary Emergency Contact #1

Primary Emergency Contact #2

Photo Release

Tuition