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Request Information/Mailing List


Thank you for your interest in Temple Emanu-El ECEC!

Please note: Your child's age group is determined by their age as of August 31st of the enrollment year.


* Indicates a required field.

Parent / Guardian Information
  • First Parent / Guardian
  • First Name *
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Cell Phone *
  • Second Parent / Guardian
    (leave blank if not applicable)
  • First Name *
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Cell Phone *
Home Address
  • Street Address
  • City
  • Country
  • State
  • Zip
  • Home Phone
  • How Did You Hear About Us? *
    Details:
  •  
  • Student 1
  • First Name *
    Middle Name
    Last Name *
  • Birthdate
    (mm/dd/yyyy)
    Gender
  • Grade Level of Interest *
    School Year *
  • Current School

  • Temple Member:
    * Yes   No

  • Religion
    *
  •  
  • Is There Another Student?
    Yes No
  •  
  • Parent / Guardian Notes
  •