ECC Registration

ECC ENROLLMENT FORM 2020-2021

I wish to enroll my child in the COMMUNITY SYNAGOGUE OF RYE EARLY CHILDHOOD CENTER for the 2020-2021 school year.
Please send a non-refundable and non-transferable deposit of $900 made out to Community Synagogue ECC.

Or you may pay with a credit card to the Synagogue Fund and write in the memo “ECC Deposit”.

Child Medical Form - Please fill this out and email it to doberlander@comsynrye.org

* Indicates required field

Child’s Name *

First

Last

Date of Birth *

Name of Parents/Guardians *

Choose Any *

Male Female

Primary Address *

Line 1

Line 2

City

State

Zip Code

Country

Primary Telephone Number *

Email *

Are you a synagogue member - Yes or No? *

Families with children enrolled in the ECC (and with older siblings having not reached the 3rd grade for the 2020/2021 school year) are invited to join the synagogue at no cost.

I wish to enroll my child in the following class (please indicate 1st and 2nd choices)

Toddler Time One day a week
2 -Year Olds:                3 Days/Week 4 Day/Week 5 Days/Week
3-Year Olds:                 3 Days/Week 4 Days/Week 5 Days/Week
4-Year Olds:                 5 Mornings Days a Week
4-Year Olds:                 2 Full Days, 3 Half Days a Week
Pre-K Program: 4 Full Days, 1 Half Day

1st Choice *

2nd Choice *

WE CAN NOT ACCOMODATE PARENTS’ REQUESTS FOR SPECIFIC TEACHERS. PLEASE TRUST THAT WE WILL PLACE YOUR CHILD IN A CLASSROOM THAT IS IN HIS/HER’S BEST INTEREST.

The first payment of 50% of the tuition is due by March 31, 2020, and the balance is due by June 30, 2020. Unless special payment arrangements have been arranged in advance, Community Synagogue of Rye Early Childhood Center shall cancel any child’s registration for non-payment by July 15, 2020.

Tuition is non-returnable, and non-transferable.

All medical and school forms for your child must be emailed to the ECC office before the first day of school.
The ECC reserves the right to consolidate or cancel a class should registration minimums not be met.

It is understood that I am responsible for the full term’s tuition even if my child is unable to complete the term. It is further understood the Community Synagogue ECC has the prerogative to request the withdrawal of a child if it feels that the child cannot adjust. In such a case, reimbursement will be pro-rated

Submit

2020-2021 Family Information and Photo Waiver - Confidential

* Indicates required field

Child's Name *

First

Last

Birth Date *

Gender *

Male Female

Address *

Line 1

Line 2

City

State

Zip Code

Country

Family’s religious affiliation *

Other Children in the family and their ages *

Child’s Special Needs (allergies, etc.) *

Home Phone Number *

Which Kindergarten will your child attend? *

First Parents Name *

First

Last

Cell Phone Number *

Email *

First Parents Profession *

Second Parent's Name *

First

Last

Phone Number *

Email *

Second Parent’s Profession *

Photo Images
From time to time, The Community Synagogue of Rye and the Early Childhood Center like to publish images of the ECC classes and activities. No child is ever identified without specific permission from a parent. If you would prefer your child
NOT be pictured.

Permissions *

I do not give permission for the Early Childhood Center to use likenesses of my child for internal purposes such as: the Synagogue Bulletin, ECC publications, other print materials and internal emails with the understanding that no child’s name will be published. I do not give permission for the Early Childhood Center to use likenesses of my child in public media such as: local newspapers, the Synagogue’s website and social media with the understanding that no child’s name will be published. I give permission for the Early Childhood Center to use likenesses of my child for internal and external purposes.

For any question related to membership or the congregation, please contact our Executive Director, Glynis Conyer at gconyer@comsynrye.org or 914-967-6262.

Submit

ALLERGY ALERT FORM

The purpose of this form is to alert the school of any known allergies.

IMPORTANT NOTE:
ANY CHILD REQUIRING SPECIAL HEALTHCARE NEEDS OR MEDICATION MUST PROVIDE INFORMATION ON AN ADDITIONAL FORM.
NO MEDICATION WILL BE ADMINISTERED WITHOUT AN APPROVED MEDICAL CONSENT FORM.

Click to download: Child Medical Statement Medical Consent Form Non Medical Consent Form

* Indicates required field

Child’s Name *

First

Last

Date of Birth *

Choose Any *

My Child has NO KNOWN ALLERGIES

Date *

MY Child HAS THE FOLLOWING ALLERGIES: *

Emergency Action Required: *

Emergency Contact #1 *

First

Last

Emergency Contact Phone #1 *

Other Phone #1 *

Emergency Contact #2 *

First

Last

Emergency Contact Phone #2 *

Other Phone #2 *

Does your child require medication? *

Choose Any *

I have provided a written Medical Consent Form

Choose Any *

I have provided an Individual Health Care Plan

Submit

ECC Emergency Information Card

* Indicates required field

Child’s Name *

First

Last

Date of Birth *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Parent's Name 1 *

First

Last

Parent 1 Cell Phone *

Parent 1 Home Phone *

Parent's Name 2 *

First

Last

Allergy Alert *

Parent 2 Cell Phone *

Parent 2 Home Phone *

If a parent cannot be reached, list 3 local contacts who you would like to be notified. Please indicate each person's relationship to the child.

Local Contact 1 *

First

Last

Local Contact 2 *

First

Last

Local Contact 3 *

First

Last

Local Contact 1 Cell Phone *

Local Contact 2 Cell Phone *

Local Contact 3 Cell Phone *

Local Contact 1 Home Phone *

Local Contact 2 Home Phone *

Phone Number *

Physician's Name *

First

Last

Physician's Phone *

Please complete and submit this form before the first day of school.

EMERGENCY CARD - Permission Statement

I give permission to Community Synagogue Early Childhood Center to take emergency measures as judged necessary for the care and protection of my child while under their supervision.

In case of medical emergency, I understand that I deemed necessary by the local emergency medical providers (i.e. EMS) my child will be transported to an appropriate medical facility by the local emergency unit.

It is understood that in some medical situations, the staff will need to contact the local emergency resource before the parent, child's physician and/or other adult acting on the parent's behalf.

Parent/Guardian's Name *

First

Last

Today's Date *

Submit

Child's History

* Indicates required field

Child's Name *

First

Last

Parent's Name 1 *

First

Last

EARLY DEVELOPMENTAL HISTORY

Choose Any *

Premature

Parent's Name 2 *

First

Last

A. Any serious health problems during 1st year of life? (illness, surgery, accidents, hospitalized): *

B. Is your child toilet trained? *

CURRENT PERSONALITY & SOCIAL ADJUSTMENT

A. Does he/she have any fears that we should be aware of at this time? *

C. What do you find most challenging about your child? *

E. Does your child have any special needs; and if so has he/she ever received or is presently receiving any services? *

B. What do you as parents find most enjoyable about your child? *

D. What aspects of his/her development do you feel we need to work on together? *

F. Please add any other information you would like us to know about your child? *

Submit

ECC ENROLLMENT FORM 2020-2021

2020-2021 Family Information and Photo Waiver - Confidential

ALLERGY ALERT FORM

ECC Emergency Information Card

EMERGENCY CARD - Permission Statement

Child's History

EARLY DEVELOPMENTAL HISTORY

CURRENT PERSONALITY & SOCIAL ADJUSTMENT

Community Synagogue of Rye
200 Forest Avenue
Rye, NY 10580

Office: 914-967-6262
Fax: 914-940-6552
info@comsynrye.org

ECC: 914-967-7698
CJL: 914-967-7598

​ECC ENROLLMENT FORM 2020-2021

2020-2021 Family Information and Photo Waiver - Confidential

​ALLERGY ALERT FORM

ECC Emergency Information Card

EMERGENCY CARD - Permission Statement

Child's History

EARLY DEVELOPMENTAL HISTORY

CURRENT PERSONALITY & SOCIAL ADJUSTMENT

Community Synagogue of Rye200 Forest AvenueRye, NY 10580

Office: 914-967-6262Fax: 914-940-6552info@comsynrye.org

ECC: 914-967-7698CJL: 914-967-7598

ECC ENROLLMENT FORM 2020-2021

ALLERGY ALERT FORM

Community Synagogue of Rye
200 Forest Avenue
Rye, NY 10580

Office: 914-967-6262
Fax: 914-940-6552
info@comsynrye.org

ECC: 914-967-7698
CJL: 914-967-7598