Student Information

*Last Name

*First Name

*Hebrew Name


*Date of Birth




*Postal Code


*Home Phone

*Current School

*Grade (2023-24)

General Note

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

Emergency 3

Enrollment Options / Tuition & Fees

Please choose enrollment options



Total Amount:

These fees will only be charged upon acceptance of your child

Payment Information

Upon acceptance, a $500 non-refundable and non-transferable payment will be charged.

For credit card payments, a 3% fee will be added (aside for the deposit). If paying by cheque, upon acceptance, please drop off 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 Postal Code

I agree to the terms and conditions above