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Student/Camper Application Form

Print Application

Print Parent Handbook

Child's Information

*Last Name

*First Name

*Hebrew Name

*Date of Birth

*Address

*City

*Postal Code

*Home Telephone

Is there any special information we should know about your child? (If yes, please elaborate.)

Has your child attended Preschool programs before? Yes   No

If yes, which one?

Names and ages of other siblings

  

 

Father's Information

*Name

*Cell Phone

*E-mail Address

Occupation

Company Name

Company Address

Company Phone

*Is father's home address the same as child's (address above)? Yes   No

If no, please provide address below: 

    

 

Mother's Information

*Name

*Hebrew Name

*Cell Phone

*E-mail Address

Occupation

Company Name

Company Address

Company Phone

*Is mother's home address the same as child's (address above)? Yes   No

If no, please provide address below:

 


General Information

How many days will your child be attending?
2 (Tues-Thurs) 3 (Mon-Wed-Fri) 5

What time will your child be attending?
AM (9:00am-12:00pm) (all ages)
PM (12:30-3:30pm) (JK/SK)
Long Day (9:00am-3:30pm) (all ages)
Full Day (7:30am-6:00pm) (all ages)

If your child is only attending the morning program, will he/she be staying for lunch? (school only)
Yes    No

Will you be doing early drop-off (7:30 am)? (school only)
Yes No

What program will your child be attending?
Pre-School/Daycare    Camp (July-Aug 2017)     Both School & Camp (Sept 2017-June 2018)

If your child will have different schedules for camp and school (i.e. different days or hours), please write what you would like for each separately below:



*My child will start in the month of ,
in the year

Have there been any conversions in the family? Yes   No

If yes, please elaborate



Was this child born to a Jewish mother? Yes   No

Are you a member of a Synagogue? Yes   No

If yes, which one?

 

Medical Information

*Pediatrician Name

*Pediatrician Telephone

*Pediatrician Address

Allergies or Medical Conditions:

  

*Does your child have any communicable diseases?  Yes   No

If yes, please elaborate  

In case of emergency, contact (other than parent)

Emergency Contact #1

*Name

*Address

*Relationship to Child

*Telephone

Cell

Emergency Contact #2

*Name

*Address

*Relationship to Child

*Telephone

Cell

Permission to receive emergency care

I hereby grant permission to Gan Shalom Preschool to take whatever steps are necessary to
obtain emergency medical care if warranted. These steps may include but are not limited to the following:

1. Attempt to contact parent.
2. Attempt to contact child’s physician.
3. Attempt to contact emergency contact person.

If we cannot contact the above, we will do all or any of the following:

1. Call another physician.
2. Call an ambulance.
3. Have the child taken to the nearest emergency room at a hospital by a staff member.

Any expenses incurred under the circumstances will be borne by the child’s family.

Gan Shalom will not be responsible for any incident that may occur as a result of false information given at the time of enrolment. I hereby allow Gan Shalom to take my child off school grounds for all trips, outings, and walks.
 
Photography consent

I hereby give Gan Shalom Preschool and Daycare permission to photograph my child for public use.

Parent/ Caregiver Contract

I hereby make application for the enrollment of my child as a pupil at Gan Shalom Preschool and Daycare for the year 2017/2018.

With my school application I am including a deposit in the amount of $500. I understand that this deposit is non-refundable under any circumstances. I am also including a registration fee in the amount of $100. I understand that this registration fee is non-refundable under any circumstances.

With my camp application, I am including a payment for half of July’s tuition dated for the date of registration. I understand that this deposit is non-refundable. I am also including the other half of July’s tuition, post-dated for March 1, 2017 and my August payment, post dated for August 2017.

I agree that if I withdraw my child from any of the programs at any time during the school year or camp, I will not receive any refund for my deposit, registration fee and already cleared payments. I understand that I am required to give a month’s notice at the beginning of the month (or be charged for that month) and will ONLY be refunded for the months my child will no longer be attending.

I agree to abide by the rules and regulations of the school. 

I have read, understand and agree to abide by ALL school policies as per above (including Permission to receive emergency care,  Photography consent and Parent/ Caregiver Contract) and our Parent Handbook.

*Parent’s signature:

AttentionImportant
To secure your spot, include (if you are on Fee Assistance, only forms are necessary):

Gan Shalom School Checklist 
* $500 non-refundable deposit dated for the date of registration (deducted from annual fee) 
* $100 non-refundable registration fee dated for the date of registration 
* 10 post dated cheques for tuition (September 2017-June 2018) 
* Completed registration forms (this electronic form and Carpool Form - print and submit) 
* Up to date immunization forms

Gan Shalom Camp Checklist

If enrolling for camp and school  
Add 2 post dated cheques for tuition (July-August 2017)

If enrolling ONLY for camp 
* Half of July’s tuition dated for the date of registration (this deposit is non-refundable) 
* The other half of the July tuition, post-dated for March 1, 2017 
(Please note: Should you withdraw from the camp program anytime after May 1st, this half of deposit is non-refundable.
* August cheque, post dated for August 2017  
* Completed registration forms (this electronic form and Carpool Form - print and submit)
* Up to date immunization forms

Please Note: Your registration will not be accepted without all of the above items

Please keep in mind, that we do our best to accommodate all ‘same group’ requests but we cannot guarantee that all requests will be possible.

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