Registration for Hebrew School

Number of children registering*

Child 1

Child's Full Name*

First Name Last Name

Child's Hebrew Name*

Gender*

FemaleMale

Child's Date of Birth*

Month Day Year

This child was born to a Jewish mother* If no, please contact Rabbi Shlomo Vorovitch 416-318-6565

YesNo

Allergies or medical conditions*

YesNo

Please elaborate on allergies / medical conditions* In case of an emergency, we will call 911

Grade starting in September*

School currently attending

Child attended Hebrew School before

YesNo

Name of Hebrew School

I would like my child to be with the following friends, if possible

Is there anything else you would like to tell us about your child?

Program Information

$75 registration fee will be charged upon form submission. The balance will be divided in 3 equal payments due October, November and December.

Program* Hebrew School closed for holidays

General Registration: $800Gan Shalom 2023-2024 Student Special: $750

Child 2

Child's Full Name*

First Name Last Name

Child's Hebrew Name*

Gender*

FemaleMale

Child's Date of Birth*

Month Day Year

This child was born to a Jewish mother* If no, please contact Rabbi Shlomo Vorovitch 416-318-6565

YesNo

Allergies or medical conditions*

YesNo

Please elaborate on allergies / medical conditions In case of an emergency, we will call 911

Grade starting in September*

School currently attending

Child attended Hebrew School before

YesNo

Name of Hebrew School

I would like my child to be with the following friends, if possible

Is there anything else you would like to tell us about your child?

Program Information

$75 registration fee will be charged upon form submission. The balance will be divided in 3 equal payments due October, November and December.

Program* Hebrew School closed for holidays. Sibling discount applied.

General Registration: $800 (Sibling $775)Gan Shalom 2023-2024 Student Special: $750

Child 3

Child's Full Name*

First Name Last Name

Child's Hebrew Name*

Gender*

FemaleMale

Child's Date of Birth*

Month Day Year

This child was born to a Jewish mother* If no, please contact Rabbi Shlomo Vorovitch 416-318-6565

YesNo

Allergies or medical conditions*

YesNo

Please elaborate on allergies / medical conditions In case of an emergency, we will call 911

Grade starting in September*

School currently attending

Child attended Hebrew School before

YesNo

Name of Hebrew School

I would like my child to be with the following friends, if possible

Is there anything else you would like to tell us about your child?

Program Information

$75 registration fee will be charged upon form submission. The balance will be divided in 3 equal payments due October, November and December.

Program* Hebrew School closed for holidays. Sibling discount applied.

General Registration: $800 (Sibling $775)Gan Shalom 2023-2024 Student Special: $750

CHILD 4

Child's Full Name*

First Name Last Name

Child's Hebrew Name*

Gender*

FemaleMale

Child's Date of Birth*

Month Day Year

This child was born to a Jewish mother* If no, please contact Rabbi Shlomo Vorovitch 416-318-6565

YesNo

Allergies or medical conditions*

YesNo

Please elaborate on allergies / medical conditions In case of an emergency, we will call 911

Grade starting in September*

School currently attending

Child attended Hebrew School before

YesNo

Name of Hebrew School

I would like my child to be with the following friends, if possible

Is there anything else you would like to tell us about your child?

Program Information

$75 registration fee will be charged upon form submission. The balance will be divided in 3 equal payments due October, November and December.

Program* Hebrew School closed for holidays. Sibling discount applied.

General Registration: $800Gan Shalom 2023-2024 Student Special: $750

Home Phone*

Area Code Phone Number

Home Address*

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

Father's Full Name*

First Name Last Name

Father's Hebrew Name*

Father's Cell Phone*

Area Code Phone Number

Father's E-mail*

Father's Occupation

Father's Company Name

Father's Company Address

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

Father's Company Phone

Area Code Phone Number

Father's Work Ext

*Is father's home address the same as child/children?*

YesNo

Father's Home Address

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

Mother's Full Name*

First Name Last Name

Mother's Hebrew Name*

Mother's Cell Phone*

Area Code Phone Number

Mother's E-mail*

Mother's Occupation

Mother's Company Name

Mother's Company Address

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

Mother's Company Phone

Area Code Phone Number

Mother's Work Ext

*Is mother's home address the same as child/children?*

YesNo

Mother's Home Address

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

Has there been any conversions in the family?*

YesNo

Please elaborate on conversion* Please contact Rabbi Shlomo Vorovitch 416-318-6565

Are you a member of a Synagogue?

YesNo

Name of Synagogue

Pediatrician*

First Name Last Name

Pediatrician's Phone*

Area Code Phone Number

Pediatrician's Address*

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

Emergency Contact 1* In case we can't reach the parents

First Name Last Name

Relationship to Child*

Cell Phone*

Area Code Phone Number

Other Phone

Area Code Phone Number

Phone type for other phone

Address*

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

Emergency Contact 2* In case we can't reach the parents

First Name Last Name

Relationship to Child*

Cell Phone*

Area Code Phone Number

Other Phone

Area Code Phone Number

Phone type for other phone

Address*

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

With my signature bellow, I confirm that the above information is true to the best of my knowledge. I confirm the enrollment of my child in Chabad Romano Centre Hebrew School and I permit my child to participate in all school activities, join in class/school trips on and off of school property. I allow pictures to be taken of my child and to be published online. In case of emergency, I hereby authorize Chabad Romano Centre Hebrew School to take whatever measures the situation may call for.

Permission to receive emergency care

I hereby grant permission to Lubavitch of Richmond Hill Hebrew school 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.

Lubavitch of Richmond Hill Hebrew school 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 Chabad Lubavitch to take my child off school grounds for all trips, outings, and walks.

Parent’s Signature:*

Referred by:

Total

$0.00 CAD

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

Registeration

HEBREW SCHOOL REGISTRATION FORM

September 2024 - May 2025

Student Information

Father's Information

Mother's Information

General Information

Medical Information

Emergency Contacts

Payment & Consent