Student Information
*First Name
*Last Name
*Hebrew Name
*Gender
*Date of Birth
*Address
*City
*Province
*Postal Code
*Home Phone
*School
*Grade (2020-21)
*If choosing Pod, list names in your pod.
Parent Information
Father
*Title
*First Name
*Last Name
*Work Phone
*Cell Phone
*Email
Mother
*Title
*First Name
*Last Name
Work Phone
*Cell Phone
*Email
*Marital Status
*Affiliation
Have there been adoptions or conversions in the family?
If yes, please explain
Medical Information
*Physician Name
*Physician Phone
Insurance
*OHIP Number
Allergies
Medical Note
Emergency Information
Name Phone # Relation
*Emergency 1
Emergency 2
Emergency 3
Enrollment Options / Tuition & Fees

Please choose enrollment options

Sessions





*Tuition (per child)
Total Amount:

You will receive a tax-deductible receipt for the entire amount.

Payment Information
Visa/MasterCard payments are accepted with a 3% fee.
.
Card Type
Card Number
Expiration Date
Security Code
Use Information above
Name on Card
Billing Address
Billing Postal Code

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