2017-2018 Shorashim & Havurat Torah Registration Form

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

First Name *

Last Name *

Email *

Preferred email address for Shorashim/Havurat Torah correspondence

Phone *

Preferred phone number for Shorashim/Havurat Torah communication

Business Phone Number

Street Address (home) *

City *

State *

Zip Code *

Adult 2

First Name

Last Name

Preferred email address for Shorashim/Havurat Torah correspondence

Phone

Preferred phone number for Shorashim/Havurat Torah communication

Business Phone Number

Street Address (home)

City

State

Zip Code

SYNAGOGUE AFFILIATION

Are you a member of Temple Israel Center? *

Yes

May join in the near future

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.

Media release *

Yes

Parent/Guardian Electronic Signature

First & Last Name *

Upcoming Events

Breakfast and Learn 5778 (2017-18)
The Bible in Song

This year, we will continue to explore Israeli songs
that serve as modern midrash on Bible stories and
characters, beginning with the patriarchs and matriarchs
of the Torah. We will listen to recordings and live music and
consider the relationship between song and biblical text, with
selected commentaries from classical rabbinic sources.

View flyer for details.

A conservative, egalitarian synagogue

2017-2018 Shorashim & Havurat Torah Registration Form

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

Shorashim (Grades K-6) and/or

Havurat Torah (Grades 7-12)

ADULT information

Adult 1

Adult 2

SYNAGOGUE AFFILIATION

Media RELEASE cONSENT

Parent/Guardian Electronic Signature

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2017-2018 Shorashim & Havurat Torah Registration Form

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

Shorashim (Grades K-6) and/or

Havurat Torah (Grades 7-12)

ADULT information

Adult 1

Adult 2

SYNAGOGUE AFFILIATION

Media RELEASE cONSENT

Parent/Guardian Electronic Signature