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?