Home
Vision Statement
Sharon Gardens
Financial Assistance
Publicity Request
Zoom Set Up Form
Facilities/Materials Request
Connect
Join
Our History
>
Past Presidents
Our Sanctuary
Our 70th Anniversary
Our Clergy
>
Cantor Cooperman's 10th Anniversary
Our Leadership
>
From the President
Governance
Nominating Committee
Our Professional Staff
Our Committees
Reform Judaism
Contact
Learn
The Early Childhood Center
>
Sharing Shabbat (ages 2-5)
Toddler Time
Programs for 2s, 3s & 4s
Pre-K Program
Summer Camp
Center for Jewish Learning
>
Grades K-2
Grades 3-6
Chavurah (Grades 5-7)
Grade 7
B'Mitzvah Program
Jewish Camping
J-Life Family Learning
CSR Teens
>
Madrichim in Training
COSY (Senior Youth Group)
College Care Packages
Adult Engagement
>
Adult B'nei Mitzvah
Sel Hubert Annual Humanitarian Speaker Series
CSR Book Club
CSR Film Class
Jewish Yoga
Mah Jongg
Scholar-in-Residence
Torah Study
SAJE
Our Wider Community
Library
Pray
Shabbat Services
>
Music
Views from the Pews
Shabbat on the Beach
Pride Shabbat
Our Holocaust Scroll
Life Cycle Events
High Holy Days
>
Yizkor
Memory Book
Past HHD Sermons & Videos
Holidays
>
Shavuot
Yom Hashoah
Passover
Purim
Chanukah
Tu B'Shevat
Sukkot
Interfaith
Healing
Yahrzeit
Songs and Prayers
Act
Mitzvah Week 2021
Jewish Greening Fellowship
Empty Nest - Full Life
Hesed (Loving Kindness)
Kulanu (All of Us)
Rye Women's Interfaith
Social Action
Women of CSR
Explore
Rabbi Gropper's Video Message
Live Video Streaming
Judaica Shop
Newsletters
>
Archived Newsletters
Photo Archives
>
2020 Photo Galleries
2019 Photo Galleries
Video Gallery
>
CSR Gala Video Gallery
Sound Cloud
Donate
CSR Funds
Calendar
ShulCloud
2020-2021
Family Information and Photo Waiver -
Confidential
*
Indicates required field
Child's Name
*
First
Last
Birth Date
*
Gender
*
Male
Female
Entering Class (e.g. 2's, 3's, or 4's)
*
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 a
t
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
[object Object]
Emergency Contact Phone #1
*
Other Phone #1
*
Emergency Contact #2
*
First
Last
[object Object]
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
[object Object]
Today's Date
*
Submit
Child's History
*
Indicates required field
Child's Name
*
First
Last
Parent's Name 1
*
First
Last
Parent's Name 2
*
First
Last
EARLY DEVELOPMENTAL HISTORY
Choose Any
*
Premature
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