NEW Student Registration

GAN SHALOM REGISTRATION FORM
Student Information
Child's Full Name*

First Name Last Name
Child's Hebrew Name (if there is, in English)
Gender*

FemaleMale
Child's Date of Birth*

Month Day Year
Home Phone
E-mail for registration confirmation*
I would like to receive news and updates by email

Child's Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Program for Sept-Aug*

Infants (3 - 18 months) $747.14Toddler (18 months-2.5 Y) $634.57Nursery (2.5Y-3.5 years old) $585.16I am eligible for YR Fee assistant
Before & After Care Sept-Aug* No additional fee but LIMITED SPOTS AVAILABLE

Early Drop off 7:45-8:15 amLate Pickup 5:00-5:30 pmBoth optionsNo need for Before & After Care
Date my child will be starting*

Month Day Year
My child will be receiving York Region Fee Assistance*

YesNoI don't know yet
This child was born to a Jewish mother*

YesNo
Comments
Has there been any conversions in the family?*

YesNo
If yes, please elaborate on conversion
Medical Information
Any Allergies or medical conditions?*

YesNo
If yes please add details
Does your child have any communicable diseases?*

YesNo
If yes please add details
Is there anything else you would like to tell us about your child?*
Mother's Information
Mother's Full Name (current name not maiden name)*

First Name Last Name
Mother's Cell Phone*
Mother's Hebrew Name (If there is, in English)
Mother's E-mail*
Is mother's home address the same as child/children?*

YesNo

Mother's Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Mother's Occupation
Mother's work Phone
Mother's work Phone Ext
Father's Information
Father's Full Name*

First Name Last Name
Father's Cell Phone*
Father's Hebrew Name*
Father's E-mail*
Father's Occupation
Father's work Phone
Father's Work Ext
Is father's home address the same as child/children?*

YesNo

Father's Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Emergency Contacts
Pediatrician*

First Name Last Name
Pediatrician's Phone*

Pediatrician's Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

In case of emergency, contact if we can't reach the parents we will contact these people:
Emergency Contact 1*

First Name Last Name
Relationship to Child*
Cell Phone*
Other Phone
Emergency Contact 2*

First Name Last Name
Relationship to Child*
Cell Phone*
Other Phone
Payment & Consent
Payment Information

1. The non-refundable deposit fee will be charged upon form submission. This deposit will be applied to your September school fee.
2. The balance will be charged to your card monthly. (The card with which you paid the registration fee).
3. If you are getting York Region Fee Assistance, you will not be required to pay the registration fee.

See full price info HERE
I give the staff at Gan Shalom Preschool, permission to apply the following:*

SunscreenDiaper CreamLotionLip BalmHand Sanitizer
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 enrollment. I hereby allow Gan Shalom to take my child off school grounds for all trips, outings, and walks.
*

I Consent to the above Emergency Care
Photography Consent*

I hereby give Gan Shalom Preschool and Daycare permission to photograph my child for public use.I don't give permission
Parent/Caregiver Contract
I hereby make application for the enrollment of my child as a pupil at Gan Shalom Preschool and Daycare.
*

With my school application I am including my first month's tuition (usually September) as a deposit. I understand that this deposit is non-refundable under any circumstances.
*

I understand that I am required to give a two 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.
Must read before you sign: Parents Handbook
*

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:*
If you're planning on using a car pool, you have to print, sign and submit this Carpool Form.

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.
Please submit up to date immunization forms.*
Total

$0.00 CAD
This credit card will be used for the monthly payments. You will get an invoice from our bookkeeper so you will know what charges to expect.

Payment*

Credit Card

We accept Visa, MasterCard
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Should be Empty:

This page uses TLS encryption to keep your data secure.

GAN SHALOM REGISTRATION FORM

Student Information

Medical Information

Mother's Information

Father's Information

Emergency Contacts

Payment & Consent

Parent/Caregiver Contract

More in this section