*Last Name
*First Name
*Hebrew Name
*Gender Male Female
*Date of Birth
*Address
*City
*Province
*Postal Code
*Home Phone
*School
*Grade
Place my Child with
*Physician Name
*Physician Phone
*Ohip Number
*Allergies
Medical Note
*Title --Select Title-- Mr. Dr.
*Work Phone
*Cell Phone
*Email
*Title --Select Title-- Ms. Mrs. Dr.
Work Phone
*Marital Status --Select -- Married Divorced Seperated Single
*Affiliation --Select -- Adath Israel Beth David Beth Emeth Beth Jacob - Hamilton Beth Radom Beth Shalom Beth Torah Beth Tzedec Darchei Noam Family Shul - Chabad Forest Hill Jewish Centre Holy Blossom None Oraynu Cong. Other Shaarei Shomayim Shaarei Tefilah Temple Emanuel Temple Sinai Village Shul
Name Phone # Relation
*Emergency 1
Emergency 2
Please choose enrollment options
*Tuition --Select-- 1/2 Day - Both Sessions 1/2 Day - Session 1 1/2 Day - Session 2 Full Day - Both Sessions Full Day - Session 1 Full Day - Session 2
Bus Transportation --Select-- Bus Depot - Armour Heights
Total Amount:
A $500 nonrefundable deposit is included.
*Card Type --Card Type-- Visa MC
*Card Number
*Expiration Date --Month-- 01 02 03 04 05 06 07 08 09 10 11 12 --Year-- 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037
*Security Code
Use Information above
*Name on Card
*Billing Address
*Billing Postal Code
Upon registering your child, a non-refundable deposit will be charged to your credit card. This deposit goes toward tuition. The reminaing balance will be charged on May 1. Please note that there are no tuition credits or make up days for illness, holidays or family vacations. Refund Policy: Before May 1 - 50% refund, after May 1 – No refund, no exceptions. There is no refund for daily/weekly absences or for sessions already in progress. Please note that all cancellations must be made via email. The deposit and all fees paid are Non-Refundable and Non-Transferable, no exceptions. Please click the box to acknowledge that you accept the terms and conditions of our Payment and Refund policy.
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