Youth Census



    Parent Information

    First Name
    Last Name
    Email

    Child Information

    Child 1
    First Name
    Middle Name
    Last Name
    Hebrew Name (transliterated)
    Date of Birth
    Gender
    Preferred Pronouns
    Please Specify Preferred Pronouns
    Will your child be attending school or day care in September 2019?
    YesNo
    Name of school or day care facility
    Grade (as of 9/2019)
    School Attending (as of 9/2019)
    Will your child be attending Summer Camp?
    YesNo
    Name of Camp

    Your child's personal information will not be available to anyone outside of Temple Emanuel Staff. We will never share this information and will only use it to contact your child regarding synagogue programming.

    Child's Cell Phone

    Child's Email
    My child is planning on participating in the following Jewish Educational Programs:
    Jewish Day SchoolProzdorReligious School Madrich (TA)Private TutoringGatewaysOtherNone of the Above

    Please specify which Jewish Educational Program:


    What is your child’s social media handle / username on Instagram?

    Does your child have an allergy to any medications?
    YesNo
    To which medications?

    Does your child have any food allergies or dietary restrictions (besides keeping Kosher)?

    YesNo
    To which foods?


    Add another child?


    Yes

    Child 2
    First Name
    Middle Name
    Last Name
    Hebrew Name (transliterated)
    Date of Birth
    Gender
    Preferred Pronouns
    Please Specify Preferred Pronouns
    Will your child be attending school or day care in September 2019?
    YesNo
    Name of school or day care facility
    Grade (as of 9/2019)
    School Attending (as of 9/2019)
    Will your child be attending Summer Camp?
    YesNo
    Name of Camp

    Your child's personal information will not be available to anyone outside of Temple Emanuel Staff. We will never share this information and will only use it to contact your child regarding synagogue programming.

    Child's Cell Phone

    Child's Email
    My child is planning on participating in the following Jewish Educational Programs:
    Jewish Day SchoolProzdorReligious School Madrich (TA)Private TutoringGatewaysOtherNone of the Above

    Please specify which Jewish Educational Program:


    What is your child’s social media handle / username on Instagram?

    Does your child have an allergy to any medications?
    YesNo
    To which medications?

    Does your child have any food allergies or dietary restrictions (besides keeping Kosher)?

    YesNo
    To which foods?


    Add another child?


    Yes

    Child 3
    First Name
    Middle Name
    Last Name
    Hebrew Name (transliterated)
    Date of Birth
    Gender
    Preferred Pronouns
    Please Specify Preferred Pronouns
    Will your child be attending school or day care in September 2019?
    YesNo
    Name of school or day care facility
    Grade (as of 9/2019)
    School Attending (as of 9/2019)
    Will your child be attending Summer Camp?
    YesNo
    Name of Camp

    Your child's personal information will not be available to anyone outside of Temple Emanuel Staff. We will never share this information and will only use it to contact your child regarding synagogue programming.

    Child's Cell Phone

    Child's Email
    My child is planning on participating in the following Jewish Educational Programs:
    Jewish Day SchoolProzdorReligious School Madrich (TA)Private TutoringGatewaysOtherNone of the Above

    Please specify which Jewish Educational Program:


    What is your child’s social media handle / username on Instagram?

    Does your child have an allergy to any medications?
    YesNo
    To which medications?

    Does your child have any food allergies or dietary restrictions (besides keeping Kosher)?

    YesNo
    To which foods?


    Add another child?


    Yes

    Child 4
    First Name
    Middle Name
    Last Name
    Hebrew Name (transliterated)
    Date of Birth
    Gender
    Preferred Pronouns
    Please Specify Preferred Pronouns
    Will your child be attending school or day care in September 2019?
    YesNo
    Name of school or day care facility
    Grade (as of 9/2019)
    School Attending (as of 9/2019)
    Will your child be attending Summer Camp?
    YesNo
    Name of Camp

    Your child's personal information will not be available to anyone outside of Temple Emanuel Staff. We will never share this information and will only use it to contact your child regarding synagogue programming.

    Child's Cell Phone

    Child's Email
    My child is planning on participating in the following Jewish Educational Programs:
    Jewish Day SchoolProzdorReligious School Madrich (TA)Private TutoringGatewaysOtherNone of the Above

    Please specify which Jewish Educational Program:


    What is your child’s social media handle / username on Instagram?

    Does your child have an allergy to any medications?
    YesNo
    To which medications?

    Does your child have any food allergies or dietary restrictions (besides keeping Kosher)?

    YesNo
    To which foods?