The Jewish Heritage School Registration - Form - Congregation Habonim of Toronto

Application for School Enrollment 2017-2018

* Please Choose one

A $200 deposit is required upon registration. Outstanding amounts are due on or before December 31, 2017.

Student Information

* First Name

* Last Name

* Date of Birth

Hebrew Name

Hebrew Birthday

Primary Parent Contact

* First Name

* Last Name

Home Phone

* Email

* Cell Phone

Work Phone

* Address

* City

* Province

* Postal Code

Secondary Parent Contact

First Name

Last Name

Home Phone

Cell Phone

Address

City

Province

Postal Code

* Are you a member of Congregation Habonim?

YesNo

* Has your child attended Hebrew School before?

YesNo

If yes where?

* What Grade will your child be entering in September?

* Health Card Number

Allergies/Health Concerns

If student has an anaphylactic allergy please submit a recent photo for easy identification and indicate if an epi-pen is carried.

Special Needs

Does your child have any speical needs, learning or behavioural difficulties that we should be aware of: (ie: hearing, vision, lack of confidence etc?)

* May we include your child's information on a school roster? (name, address, phone)

YesNo

* I give my permission for my son/daughter to be photographed or videotaped by representatives of The Jewish Heritage School at Congregation Habonim for the photos and/or videos to be used by the The Jewish Heritage School and Congregation Habonim for publications and displays.

YesNo

* The Jewish Heritage School and Congregation Habonim have their own websites on which information about our school is disseminated. Photos, videos and students' work are occasionally used on these websites, but the students involved are either not identified or are identified by first name only. I hereby agree to the use of my child's photo, video and/or work on The Jewish Heritage School website and/or the Congregation Habonim website as long as he or she identified by first name only. If my child is to be identified by more than just first name on the website, I understand that I will be asked to give explicit permission for this to be done on a case by case basis.

YesNo