The Village Shul Hebrew School 2022-23 Application Form - Form

How would you like to arrange your school fees?

Please Select OnePay in Full NowPlace a $100.00 Deposit only at this time

Which program are you registering for?

* Child's Family Name

* Child's First Name

Child's Hebrew Name

Epipen carried?

Please Select OneYesNo

* Child's Date of Birth

* Public School attending:

* Grade Entering:

* Previous Hebrew School Experience:

Was the child:

Was the child's mother:

Language spoken at home:

Are you a member of a Synagogue?

Please Select OneYesNo

Name of Synagogue:

* Does your child have any allergies

Other Allergies:

* Does your child have any special medical, or diet information/requirements.

Please provide all medical and/or diet details here.

Epipen carried?

Please Select OneYesNo

Family Physician & phone number

Does your child have an IEP or any learning issues?

Please Select OneYesNo

* Details:

* How many Adults are on this account

* Adult 1 - First Name

* Adult 1 - Last Name

* Adult 1 - Cell Phone

Adult 1 - Work Phone

* Adult 1 - Email Address

* Home Address

* Home City

* Home Postal Code

* Adult 2 - First Name

* Adult 2 - Last Name

* Adult 2 - Cell Phone

Adult 2 - Work Phone

* Adult 2 - Email Address

* Does Adult 2 live at the same address?

Adult 2 - Home Address

Adult 2 - Home City

Adult 2 - Home Postal Code

* Marital Status

Other

Please list an emergency contact in case Parents cannot be reached.

* First Name

* Last Name

* Relationship to Child

* Email

* Cell Phone

* Address

* City

Postal Code

$100 deposit or full payment is due upon submission of this form, payable online via credit card. Your payment must be paid in full.
Fees are determined on an academic year basis and take into account the length of the school months and the number of holidays or other days off during the school year.
The balance of tuition may be made paid in up to four (4) installments.
A charitable receipt will be issued for all fees paid.

I have read, understood, and agree to the abo.ve conditions of enrollment and confirm the truth and accuracy of all information provided in this application form.

* Parent #1 Name

* Date

* Parent #2 Name

* Date

Total

Note: 3% will be added for all credit card transactions. (Payments may also be made by e-transfer to asamole@aish.com, or via cheque or cash)