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Park East Synagogue
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since 1890
How goodly are thy tents, O Jacob
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/ Youth Enrichment Center – Bus Form
Name of Parent
*
First
Last
Phone
*
Email
*
Name of Student
*
Grade
*
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Name of School
*
Dismissal Time
*
Would you like to register another child?
*
Yes
No
Name of Student
*
Grade
*
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Name of School
*
Dismissal Time
*
Emergency Contact at School
Name
*
First
Last
Phone Number
*
Comments
Busing
*
Price:
Busing
*
Price:
$100.00
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$0.00
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