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 Student Application Form

Print Application

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 Hebrew School before? Yes   No

If yes, which one?

*Current School

*Current Grade

If there is more than one class for my child's grade, I would like my child to be with the following friends

 

Father's Information

*Name

*Cell Phone

*E-mail Address

*Occupation

Company Name

Company Address

Company Phone

 

Mother's Information

*Name

*Cell Phone

*E-mail Address

Occupation

Company Name

Company Address

Company Phone

 

General Information

Have there been any conversions in the family? Yes   No

If yes, please elaborate

 

Was this child born to a Jewish mother? (Jewish Law mandates that we ask this question.) Yes   No

Are you a member of a Synagogue? Yes   No

If yes, which one?

Names and ages of other siblings

 

 

Medical Information

Health Card Number in case of emergency (optional) 

*Pediatrician Name

*Pediatrician Telephone

*Pediatrician Address

Allergies or medical conditions

 

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

How did you hear about us? If you were referred to us by someone, please specify from whom you were referred.

 

Payment Information

I will be paying   Full Tuition    Partial Tuition in the amount of
$

The rest will be paid by:

Additional Payee Information

Name  

Address  

Tel    Cell

Amount Paying $  


Please send payment cheques to Chabad Romano Centre, 10500 Bathurst St., Maple, ON L6A 0H2 or pay via credit card by
clicking here 

AttentionImportant
Please print, sign and send the " Permission to Receive Emergency Care" declaration. In addition, please send a non-refundable deposit (to be deducted from the total fee).

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Updates
We love hebrew School!
It's so much fun learning about the Jewish Holidays, competing in Aleph Champ, collecting Hebrew School dollars for great prizes...
Upcoming events
Oct. 08, 2017
Sukkot / Thanksgiving