Temple Emanu-El - Emanu-El Explorers

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

Emanu-El Explorers is Back!

Designed for Pre-K to 2nd Grade students, Temple Emanu-El offers children the opportunity to “explore” Religious School.

Once a month, from January-May, children registered in the Emanu-El Explorers program will join our school’s community, participating in vibrant learning experiences centered around rich traditions and holiday celebrations.

Two Weekly Attendance Options
We offer two options per week to attend Emanu-El Explorers, occurring during Religious School hours. PLEASE NOTE THAT THE 2022 DATES HAVE CHANGED.

NEW EXPLORERS DATES:
Sundays: February 13, March 6, April 10, May 1, May 15
Mondays: February 14, March 7, April 11, May 2, May 16

Emanu-El Explorers - Sunday

Qty

Description

Amount

Total

Sunday - Members Prek-1st Grade

$250.00

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Sunday Members 2nd Grade

$250.00

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Sunday - Nonmembers PreK-1st Grade

$360.00

---

Sunday Nonmembers 2nd Grade

$360.00

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Emanu-El Explorers - Monday

Qty

Description

Amount

Total

Monday - Members PreK-1st Grade

$250.00

---

Monday Members 2nd Grade

$250.00

---

Monday - Nonmembers PreK-1st Grade

$360.00

---

Monday Nonmembers 2nd Grade

$360.00

---

Total: $0.00

STUDENT INFORMATION

Student #1

Name of student: *

Nickname:

This child will be attending Explorers on - only one box may be checked

Sundays at 9:45AM – 12:00 PM

Mondays at 4:00 PM – 5:45 PM

Gender: *

Date of birth: *

School grade of student: *

Current school or program: *

Does this student have any special needs, learning issues, or an IEP?

Special needs? *

We would like to discuss with you, in person, the special needs for this child. What date/time may we call you to discuss?

If Yes to special needs, provide date & time to contact:

MEDICAL INFORMATION

Please remember to inform the Religious School office if there are changes in the student’s health over the course of the year. All medical information is kept strictly confidential.

Please describe any allergies or special medical conditions: *

Is your child regularly on any medication? *

If Yes, please describe:

School personnel are not permitted to administer medication to students; if your child will require the above medication during Religious School hours, please detail the method by which your child receive this medication.

Please detail the method by which your child receive this medication: *

A separate Allergy Information & Epi Pen Authorization Form will be sent to all families with a child who carries an epi pen.

Does your child carry an epi pen? *

In the unlikely event of an emergency, please provide the contact info of your child’s physician

Name: *

Phone: *

In the event that no one can be reached, I give my permission for the staff of Congregation Emanu-El to take whatever emergency steps are necessary.

I give my permission: *

ADULT INFORMATION

Adult #1

Name of registering adult (must be legal parent or guardian): *

Address: *

(street, city, state, zip)

Home Phone: *

Work Phone: *

Cell Phone: *

Email: *

Relation to child(ren): *

Are you a member of Temple of Emanu-El? *

Religion of Parent:

Emergency Contact

If Adult 1 or 2 cannot be reached, please provide the following contact for emergency purposes.

Name: *

Relationship: *

Address: *

(street, city, state, zip)

Home Phone: *

Work Phone: *

Cell Phone: *

Email: *

DISMISSAL

In addition to the adults already listed, I authorize the following adult to pick up my child(ren) from this program.

Name:

Phone Number:

Mobile Phone Number:

Email:

Relationship:

ADDITIONAL INFORMATION

Please tell us how you heard about Emanu-El Explorers: *

Congregation Emanu-El reserves the right to photograph and video the children participating in Emanu-El Explorers for use in public promotion or public education of this program. It is our policy to not identify any students by name in Temple publicity. If you have questions or concerns about this policy, contact the Religious School at 212-507-9546 or school@emanuelnyc.org.

This program includes an automatic subscription to PJLibrary. If you do not wish to "sign up" for PJLibrary please contact the Religious School at 212-507-9546 or school@emanuelnyc.org upon enrollment in Emanu-El Explorers.

Why did you decide to register for Explorers this year?

Payer Information

First Name: *

Last Name: *

Billing Address: *

This is the address where your credit card statements are mailed.

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *