*Last Name
*First Name
*Hebrew Name
*Gender Male Female
*Date of Birth
*Address
*City
*Province
*Postal Code
*Home Phone
*School
*Grade (2026-27)
Anything we need to know about your child?
*Physician Name
*Physician Phone
Insurance
*OHIP Number
Allergies
Medical Note
*Title --Select Title-- Mr. Dr.
*Work Phone
*Cell Phone
*Email
*Title --Select Title-- Mrs. Ms. Dr.
Work Phone
*Marital Status --Select -- Divorced Married Separated Single
*Affiliation --Select -- Adath Israel Beth David Beth Emeth Beth Radom Beth Sholom Beth Torah Beth Tzedec Cortleigh Jewish Centre Darchei Noam Forest Hill Jeiwsh Centre Holy Blossom Ledbury Jewish Centre (Family Shul) Oraynu Cong. Shaarei Shomayim Shaarei Tefillah Temple Emanuel Temple Sinai Village Shul Other None
Have there been adoptions or conversions in the family?
If yes, please explain
Name Phone # Relation
*Emergency 1
Emergency 2
Emergency 3
Please choose enrollment options
*Tuition (per child) --Select-- Hebrew School
Total Amount:
All payments are non-refundable and non transferable. You will receive a tax-deductible receipt for the entire amount.
Visa/MasterCard payments are accepted with a 3% fee.
.
Card Type --Card Type-- Visa MC
Card Number
Expiration Date --Month-- 01 02 03 04 05 06 07 08 09 10 11 12 --Year-- 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038
Security Code
Use Information above
Name on Card
Billing Address
Billing Postal Code
GENERAL WAIVER - As the parent or legal guardian of the above child, I authorize Aleph Champ Hebrew School (ACHS) personnel to hospitalize or secure treatment for my child(ren). I agree to pay all charges for that care and/or treatment. If time and circumstances reasonably permit, ACHS personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child(ren) to participate in all school activities on and beyond school properties and allow my child(ren) to be photographed for use on the School's website and social media. I also understand that all liability and costs resulting from damage to property and/or personal injury caused or attributable to my child(ren) will be my responsibility and I agree to fully indemnify and save ACHS and its associates, teachers and agents harmless therefrom. I consent to ACHS’s use of our personal information and of our child(ren) at its discretion. WAIVER OF LIABILITY FROM COVID-19 - By submitting this waiver and release, I hereby acknowledge and agree that I, on my behalf and on behalf of my child(ren): a) understand the contagious nature of COVID-19; b) voluntarily assume the risk that me, my child(ren) or anyone for whom I am responsible may become exposed, infected, or otherwise contract COVID-19 while attending, participating in or, otherwise engaging in any activities at or in connection with Aleph Champ Hebrew School and Chabad on the Avenue. I hereby waive, release and discharge Chabad on the Avenue and its subsidiaries, their employees, agents, operators, directors, officers, volunteers, and independent contractors (“Releasees”) from any liability, claims, damage or injuries arising from said exposure. I HAVE READ AND UNDERSTAND THIS FORM. I AM AWARE THAT BY SUBMITTING THIS FORM I AM WAIVING CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE, WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS AND ASSIGNS MAY HAVE AGAINST THE RELEASEES.
I agree to the terms and conditions above
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