Private Registration Form Link - Chabad Midtown School

Registration: New Student - Private Link

Mother's information

Mother's First Name

Mother's Middle Name

Mother's Last Name

Mother's Hebrew Name

Same address?

Yes

Mother's Address

Street Address

City

Province

Postal Code

Mother's Occupation

Mother's Email Address

Mother's Cell Phone

Is the mother Jewish?

If applicable, explain any conversions in the mother's family

Mother's Maiden Name

Father's information

Father's First Name

Father's Middle Name

Father's Last Name

Father's Hebrew Name

Same address?

Yes

Father's Address

Street Address

City

Province

Postal Code

Father's Occupation

Father's Email Address

Father's Cell Phone

Is the father Jewish?

If applicable, explain any conversions in the father's family

Marital Status of Parents

Married

Separated

Divorced

Divorced for how long?

Family Synagogue Affiliation

Name of the Rabbi

Languages spoken at home

Other languages spoken at home

Emergency Contact 1:

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone Number

Emergency Contact Address

Emergency Contact 2:

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone Number

Emergency Contact Address

If an emergency arises (G-D forbid), and none of the people mentioned above can be contacted, I hereby give The Chabad Preschool/Daycare permission to take whatever measures it feels proper and necessary considering the circumstances.

My child can be released to any adult that I text to the school phone with permission. I will provide ID their first few visits until they are familiar.

Please be advised that I give my full consent to the faculty of The Chabad Preschool/Daycare to take my child for short walks or on the school bus to local parks/libraries, and the like outside the preschool/ daycare facility at any time they deem appropriate.

Signature (Type full name)

I consent that:

I have read all the policies and procedures concerning the Chabad daycare/preschool.

I am aware of the schools photo policy

I give permission for staff to use sanitizer, creams with or without DIN#, sunscreen, as necessary

I am aware chabad’s playground isn’t large enough and requires group rotations, therefore includes parks, walks etc.

I give permission for our name and contact information to be placed on a class list for release to other parents.

I give permission for staff to administer acetaminophen or ibuprofen to children with fever, while the parent is on the way, should the staff feel concerned of extreme quick rising temperatures which may lead to a seizure.

Signature of Parent (Type full name)

How would you like to pay? No cheques will be cashed or cards charged until a written confirmation that space is available.

Cheque (10 post-dated for the 1st of each month)

Credit Card (2.5% charge will be added)

Child Information

Emergency Contact 1:

Emergency Contact 2: