Leave this field empty

ECC Emergency Information


Please list names/numbers in the order in which we should call should it be necessary to do so!

Emergency Contacts (who can pick up your child if parent or guardian is unavailable):

Additional Pick-up Information

Child's Usual Source of Medical Care

Child's Usual Source of Dental Care

Child's Health Insurance

Please provide us with a copy of your child's last medical exam. We are required to keep valid copies of medical exams on file at all times. For your convenience, the medical form has been emailed to you.

In the event of a serious accident or injury to a child enrolled in The Early Childhood Center at Temple Shaaray Tefila, it is the school's policy to immediately notify the parent or guardian and to call emergency medical care. It is possible that we will not be able to locate the parent or guardian immediately, therefore it is necessary to obtain parent or guardian authorization for emergency medical treatment in the parent's or guardian's absence. The authorization is kept on file, and in case of a serious accident, when the parent or guardian cannot be reached, this statement of authorization will be taken to the hospital with the child.

Account Details

Enter your name and e-mail address for your confirmation

Payment Information


For added Security please check the box below.