Information About Child

Parent Information

Emergency Contact Information if we can't reach a Parent or Guardian

Immunization Record, COVID release form, & Behavior Contract

Authorizations

The child listed above has my permission to engage in all Temple Israel of New Rochelle (TINR) Remote Programming except as noted below.

In the event that I cannot be reached in an emergency, I hereby give permission to Temple Israel New Rochelle to seek emergency medical treatment and arrange necessary related transportation for my child. I hereby give permission to the physician/health care provider selected by Temple Israel New Rochelle to secure and administer treatment, including hospitalization, for the person named above.

Please make sure the registration form is completed in its entirety and click "register."