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Student Application

Student Application

Registration Form New Students

We are currently accepting application forms for the 2017-2018 school year. Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss with us, feel free to email dvora@chabadmt.com

Please note that one registration form per child is needed.

No child will be turned away due to lack of funds.

Student Profile
 
Name
Last
Hebrew Name
Age
DOB Time (AM or PM)
School
Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No
Where?
Does your child have any learning difficulties with General Studies? If yes, please describe
Parent Information
 
Address
City/Zip
Phone
Father's Name
Father's Occupation
Father's Cell
Father's Email
Mother's Name
Mother's Occupation
Mother's Cell
Mother's Email
Were there any conversions and/or adoptions in the family? If yes, where and when was it performed?
Emergency Information
 
Emergency Contact 1
Phone
Emergency Contact 2
Phone
Doctor's Name
Doctor's Phone Number
Medical Insurance Company
Policy Number

CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.



Tuition Agreement

Tuition for the year, per child: $850

Early Bird Special (register before June 30th): $800

SPECIAL for children registering directly from Chabad Preschool (before June 30) $400

PICKUP from Cedervale, McMurrick, Palmerston, Hillcrest, Humewood (possibly other schools) $100

 
Please check box with your choice for method of payment.
Prepayment in full before September
10 monthly installments (Sept - June) in the form of 10 postdated checks
 
Method of payment:
Check
Credit Card
 
Please mail checks to Chabad of Midtown Hebrew School, 1344 Bathurst St., Toronto ON M5R 3H7
 
Credit Card Information
Card Type Card Number
Exp Date CVV
Amount to Charge Billing Zip
Family Name  
Child 1 Cost:
Child 2 Cost:
Child 3 Cost:
Total Cost:    

 

As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad Hebrew School to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Chabad Hebrew School personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all school activities, join in class and school trips on and beyond school properties.

I Accept

Name: Initials: Date:

We look forward to a wonderful year of learning and growth!

 

 

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