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---MaleFemaleOther Preferred Pronouns---He/Him/HisShe/Her/HersThey/Them/TheirsOther 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) ---K123456789101112>12 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---MaleFemaleOther Preferred Pronouns---He/Him/HisShe/Her/HersThey/Them/TheirsOther 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) ---K123456789101112>12 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---MaleFemaleOther Preferred Pronouns---He/Him/HisShe/Her/HersThey/Them/TheirsOther 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) ---K123456789101112>12 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---MaleFemaleOther Preferred Pronouns---He/Him/HisShe/Her/HersThey/Them/TheirsOther 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) ---K123456789101112>12 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?
