A conservative, egalitarian synagogue

2017-2018 Shorashim & Havurat Torah Registration Form

Tue, 03/29/2016 - 2:52pm -- Robin Arzt

PLEASE NOTE: Fields marked with a RED ASTERISK* are mandatory.

Please complete this form to register ALL students in your family for

  • Shorashim (Grades K-6)  and/or

  • Havurat Torah (Grades 7-12)

To submit, go to the last page using the navigation buttons at the bottom and click the submit button (bottom of last page). A confirmation page will be emailed to you. Friend and session requests will be honored only upon receipt of a deposit. Questions? Please contact Jean Klipstein in the Education office, or at (914) 948-2800 x123. Thank you.

ADULT information

Adult 1
Preferred email address for Shorashim/Havurat Torah correspondence
Preferred phone number for Shorashim/Havurat Torah communication
Adult 2
Preferred email address for Shorashim/Havurat Torah correspondence
Preferred phone number for Shorashim/Havurat Torah communication

SYNAGOGUE AFFILIATION

Media RELEASE cONSENT

Please indicate if we can use your child(ren)'s photograph or likeness in photo, video, or printed marketing and/or promotional materials (names will not be included) for Shorashim, Havurat Torah, or Temple Israel Center.

Parent/Guardian Electronic Signature