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CHS Online Registration

CHS Online Registration

Chabad Hebrew School Online Registration Form

 

Student Information

Name: Hebrew Name:

Birth date: Entering grade:

Address:

City: Prov.: Postal Code:

Does your child read basic Hebrew? Yes No . If Yes:Good Fair Poor

What school does your child attend?

Was your child enrolled in a Jewish day or supplementary school in 2016-2017? Yes No . If yes, which one?

If you were referred to our school, who referred you?

Parent Information

Father's Name:

Home Phone Number: Work Phone Number:

Mobile Phone: E-mail address:

Mother's Name:

Home Phone Number: Work Phone Number:

Mobile Phone: E-mail address:

General Information

Is the natural mother of the child Jewish? Yes No

Were there any conversions or adoptions in your family? Yes No

If yes please explain:

Conversion performed by Rabbi/Beth Din:

Is the family a member of a Synagogue? No Yes

If yes which one:

Names and ages of other siblings:

Emergency Information

In case of emergency, when neither parent can be reached, please provide a contact who will take responsibility for our child.

Emergency contact (other than parent):

Home Phone: Work Phone:

Relationship:

Child's Doctor: Phone Number:

Address:

Health Card Number:

Allergies or Special needs:

If we, our emergency contact, or our phisician (as noted on this form) cannot be reached in case of medical/surgical emergency, we hereby give permission to the physician or hospital selected by the school or its selected representative, to hospitalize, secure proper treatment for our child as named above. We understand that any cost will be our responsibility.
I accept Name: Initials:

Photo Release

 I hereby give permission to Chabad Hebrew School to use school photos of my children in any Chabad Hebrew school publication to promote the school. This includes print and online publications as well as social media.

Payment Information

Pay Online: For your convenience, you can now pay for Hebrew School online.

This page uses a secure connection and your information will not be shared with anyone.

First Name Last Name

VISA Master Card

Card number: exp.(mm/yyyy) /

Please charge my credit card for the full tuition in the amount of $650.

I would like to have the following payment schedule, please charge my credit card accordingly:

My post dated cheques payable to OTC are in the mail.

Please make all cheques payable to Ottawa Torah Centre and mail to:
Ottawa Torah Centre
111 Lamplighters Drive
Ottawa, ON K2J 0C2

Thank you and looking forward to a productive year of learning and growth.

If you have any questions, please don't hesitate to contact us: chs@ottawatorahcenter.com

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