Student Information

*Last Name

*First Name

*Hebrew Name


Date of Birth




*Postal code

*Home Phone

Previous School

Group Child with (no guarantees)

Medical Information

*Physician Name

*Physician Phone


*Ohip Number


Medical Note

Parent Information


*First Name

*Last Name

*Work Phone

*Cell Phone




*First Name

*Last Name

Work Phone

*Cell Phone


*Marital Status


Have there been adoptions or conversions in the family?

If yes, please explain

Emergency Information

Name Phone # Relation

*Emergency 1

*Emergency 2

Enrollment Options / Tuition & Fees

Please choose enrollment options



Total Amount:

$595 deposit charged now. The balance in 6 payments on: Jan 1, March 1, May 1, Jul 1, Sept 1, Dec 1, 2020. JK: $1500 deposit charged now. The balance in 7 monthly payments on: Sept. 15, Oct 15, Nov 15, Dec 15, Jan 15, Feb 15, Mar 15

Payment Information

For credit card payments, a 3% fee will be added. If paying by cheque, please drop off the deposit and post dated cheques at our office to secure your child's spot.


Card Type

Card Number

Expiration Date

Security Code

Use Information above

Name on Card

Billing Address

Billing Zip code

I agree to the terms and conditions above