Gan Chamesh Forms 2026

My Child's Profile
Name

First NameLast Name
Name Called
How would you like your child's name to appear around the classroom and on projects?
Full Hebrew Name
Child's Birthday

MonthDayYear
Date
Child's Hebrew Birthday
Has your child been evaluated for services? When? For what?
FOR US TO BEST HELP YOUR CHILD, PLEASE SEND US THE REPORTS FROM PREVIOUS EVALUATIONS AND/OR A RELEASE TO RECEIVE THEM FROM THE EVALUATING AGENCY.
Is your child currently receiving any services?
Service provider:
Type of service:
Times per week:
Location:
Name of Therapist:
Therapist Phone Number:
Please feel free to add anything else, which you consider important to your child's success:

Grandparent Information

Please complete this section so we can share your nachas!
Maternal Grandparents Full Name:
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Paternal Grandparents Full Name:
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I would like to submit additonal grandparents information
Number of Additional Grandparents to Submit
Grandparents Full Name:
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Grandparents Full Name:
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Grandparents Full Name:
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency File
Child's Name

First NameLast Name
Birth Date

MonthDayYear
Date
Father's Name

First NameLast Name
Mother's Name

First NameLast Name
Child's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mother's Contact Info
Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Father's Contact Info
Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
My child may be picked up from school by:
Pickup Person #1

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Pickup Person #2

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Pickup Person #3

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contacts
Emergency Contact #1

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to child:
Emergency Contact #2

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to child:
Emergency Contact #3

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to child:
My Child's Pediatrician:
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Permission for Emergency Medical Treatment:
In case of any medical emergency whereby parents or legal guardians cannot be reached, I hereby authorize the school to take appropriate medical action.
Permission for Emergency Medical Treatment - Parent's E-Signature
Date

MonthDayYear
Date
Allergies / Medical Conditions
ALLERGY ALERT
Gan Chamesh is a nut-aware school!
All lunch items and snacks must be nut free and free of any traces of nuts . Please read all labels to ensure the health and safety of all of our students. Your child’s teacher will guide you as to where Shabbos treats and birthday treats should be purchased so they can be enjoyed by all our students.

Thank you for your cooperation on this matter!
Child's Name

First NameLast Name
Does your child have any allergies? Please list:
What should be done in the event of an allergic reaction?
Does your child have an epi-pen?
* In case of any severe allergies, please meet with your child’s teacher to discuss details and to pick up necessary paperwork to be completed by your child’s pediatrician.
Does your child have any medical conditions the school should be aware of?
We are not authorized to administer any medication including nebulizers.
Nap Agreement
I am aware that during Quiet Time and Rest (when applicable) children will be on mats (provided by the home) in the classroom and supervised by classroom teachers.
Nap Agreement -Parent's E-Signature
Date

MonthDayYear
Date
Medical Form
If you already have the medical form completed you can upload it below. If not please email the completed form to info@ganchamesh.com or fax it to 516-295-7840
Medical Form Upload

Cancelof
Medical Statement

MEDICAL STATEMENT GAN CHAMESH 2026 - 2027
Please be aware that as per the Department of Health, the Office of Children and Family Services, as well as the State Education Department, NO CHILD will be admitted to school without an up-to-date Medical/Vaccination Form indicating that your child has received the MMR vaccination. Thank you in advance for your cooperation.I HAVE READ AND UNDERSTAND THE ABOVE STATEMENT AND WILL SUBMIT MY CHILD’S MEDICAL FORM BY AUGUST 27, 2026
Medical Statement - Parent's E-Signature
Date

MonthDayYear
Date
Permission & Release
I understand that my address, phone number and cell phone number will be compiled into a class list and will be distributed to all the families in my child’s class.I understand that pictures and/or videos taken of my child at Gan Chamesh during school hours may be posted on the Gan Chamesh website or on Gan Chamesh/Chabad social media and may be used for promotional purposes. I hereby give permission for my child

First NameLast Name
To go on all outings and trips with his / her class throughout the school year. Permission and Release - Parent's E-Signature
Date

MonthDayYear
Date
Emails
Email and WhatsApp are our chosen methods of communication. It is imperative that you save the Gan Chamesh office number, (516) 295-2479 as a contact in your phone, in order to receive Gan Chamesh WhatsApps.

- Please do not unsubscribe to our emails as all pertinent information (school closures, event announcements, reminders etc.) will be sent via email.

- Please make sure to add our email info@ganchamesh.com to your contact list so that our important emails are directed to your primary inbox and don’t get lost among your Junk Mail.
Please list any email addresses we should use to notify parents or caretakers of important school information and updates:
Please list all cell phone numbers we should use to notify parents or caretakers of important school information and updates by WhatsApp.
Signature
Date

MonthDayYear
Date

Parent Involvement

We encourage parents to get involved in our P.T.A. We lookforward to greeting you as a volunteer and working together with our parent body to create the most meaningful activities for our Gan Chamesh family
Below Are Some Opportunities For Parents To Volunteer At In Gan Chamesh: Please Choose All That You Would Like To Be Involved With:
Do You Have Any Services Or Goods You Would Like To Offer:
Please share the services or goods you would like to offer.
Should be Empty:

My Child's Profile

Grandparent Information

Emergency File

Emergency Contacts

Permission for Emergency Medical Treatment:

Allergies / Medical Conditions

Nap Agreement

Medical Form

Medical Statement

Permission & Release

Emails

Parent Involvement