Private Registration Form Link - Chabad Midtown School

Registration: New Student - Private Link

Child Information

First Name

Middle Name

Last Name

Hebrew Name

Address

Street Address

City

Province

Postal Code

Date of Birth

I am enrolling for

5 full days

3 full days

2 full days

5 mornings

3 mornings

2 mornings

Applications are only accepted six months in advance and only once a child is born.

Beginning on the first of the month of

Family Doctor (first & last name)

Doctor Address

Doctor's Office Phone

Any Allergies or Medical Problems?

Yes

Explain any Allergies or Medical Problems

Has your child had any history of communicable diseases or requiring medical attention?

Yes

Please explain any history of communicable diseases or requirement for medical attention

Any special requirements relating to diet, rest or exercise?

Yes

Please give details concerning any special requirements relating to diet, rest or exercise.

Are there any conditions or behaviours that require special attention, medication?

Yes

Please explain any conditions or behaviours that require special attention, medication

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

Location Preference

Enter your desired location in order of preference by inputting a number in each of these locations below.

1344 Bathurst St

544-546 S. Clair Ave West

1034 S. Clair Ave West (Cnr Glenholme)

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 understand that Chabad Midtown has 3 local locations and they will do their best to accommodate what’s most convenient for my family.

Initials

Chabad may need to move our child, to another of the 3 locations, if they feel our child will benefit developmentally or capacity, class dynamics, or another families needs. We recognize we are part of a community not exclusively a service.

Initials

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 that Chabad’s Bathurst location 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)