Records Consent Form

By completing and submitting this electronic form, I give Dr. Naomi Adler and other WDS faculty/staff, consent to communicate about my child with the private professionals and/or agencies listed below.

Date:

*Student's Name

*Student's Date of Birth

*Student's Address

Street, City, State & Zip Code

*Student's Current Grade

*Parent/Legal Guardian's Name

*Parent/Legal Guardian's Name

*Name

*Name of Agency

*Agency Address

Street, City, State & Zip Code

*Agency Phone Number

xxx-xxx-xxxx

2nd Name

2nd Name of Agency

2nd Agency Address

Street, City, State & Zip Code

2nd Agency Phone Number

xxx-xxx-xxxx

Find Us

856 Orienta Avenue
Mamaroneck, NY 10543
914-698-8900

Who We Are

Westchester Day School is a Modern Orthodox, co-educational, dual-curriculum, toddler to 8th grade Jewish school that inspires and educates our students in their own way to value menschlichkeit, mitzvot, and lifelong learning.

Accreditations

Resources

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