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STUDENT/CAMPER APPLICATION FORM

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.)


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:

 


Program Attending

PRESCHOOL (8:15-3:00, closed for breaks)
 Unavailable due to COVID 2 Mornings (Pre-Nursery & Nursery): Tues & Thurs, 9:00 am-12:00 pm
      (N/A for Camp)
 Unavailable due to COVID 3 Mornings (Pre-Nursery & Nursery): Mon, Wed & Fri, 9:00 am-12:00 pm
      (N/A for Camp)
5 Mornings (Pre-Nursery & Nursery): Mon-Fri, 9:00 am-12:00 pm

 Unavailable due to COVID 2 Mornings with early drop (Pre-Nursery & Nursery): Tues & Thurs, 8:15 am-12:00 pm
      (N/A for Camp)
 Unavailable due to COVID 3 Mornings with early drop (Pre-Nursery & Nursery): Mon, Wed & Fri, 8:15 am-12:00 pm
      (N/A for Camp)
5 Mornings with early drop (Pre-Nursery & Nursery): Mon-Fri, 8:15 am-12:00 pm
     (N/A for Camp)

 Unavailable due to COVID 2 Extended Days (Pre-Nursery & Nursery): Mon-Fri, 9:00 am-3:00 pm with lunch
      (N/A for Camp)

 Unavailable due to COVID 3 Extended Days (Pre-Nursery & Nursery): Mon-Fri, 9:00 am-3:00 pm with lunch
      (N/A for Camp)

5 Extended Days (Pre-Nursery, Nursery & JK): Mon-Fri, 9:00 am-3:00 pm with lunch

DAYCARE (8:15-5:00, open during breaks)
 Unavailable due to COVID 2 Full Days (Pre-Nursery & Nursery): Tues & Thurs, 8:15 am-5:00 pm with lunch
      (N/A for Camp unless continuing for school year)

 Unavailable due to COVID 3 Full Days (Pre-Nursery & Nursery): Mon, Wed & Fri, 8:15 am-5:00 pm with lunch
       (Fri: No later than 1 hour before Shabbat)  (N/A for Camp unless continuing for school year)

5 Full Days (all ages): Mon-Fri, 8:15 am-5:00 pm with lunch (Fri: No later than 1 hour before Shabbat)


Which session will your child be attending?
Camp (July-Aug 2020)     Pre-School/Daycare (Sept 2020-June 2021)     Both Camp & School (July 2020-June 2021)

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 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 2020/2021.

With my school application I am including my first month's tuition as a deposit. I understand that this deposit 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, 2020 and my August payment, post dated for August 2020.

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:

Referred by: 

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

Gan Shalom Camp Checklist
If enrolling for camp and school
  
Add 2 post dated cheques for tuition (July-August 2020)

If enrolling ONLY for camp
* July’s tuition fee as deposit, post dated for March 1, 2020
(Please note: Should you withdraw from camp anytime after May 1st, this deposit is non-refundable
* August cheque, post dated for August 2020 
* Completed registration forms (this electronic form and
Carpool Form - print and submit)
* Up to date immunization forms

Gan Shalom School Checklist
* First month's tuition fee as a non-refundable deposit (dated for the date of registration)  
* 9 post dated cheques from October 2020-June 2021
* 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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