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Yachad Registration Form

Yachad Registration Form

Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss with us, please contact us.

If you prefer you can download a 'Printer Friendly' Form and mail, email, or fax it to our office.

We look forward to a wonderful year of learning and growth.


Student Profile
First Name
Last Name
Hebrew Name
Gender
Date of Birth
School Attending
Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Hebrew Language
Proficiency
None Somewhat Well
Previous Jewish Education Yes No
Where?
Learning Difficulties Yes No
  If yes, please describe:
Alberta Health #
 
 

Parent Information

Father's Information
First Name
Hebrew Name
Work Phone Number
Cell Phone Number
Email Address
Mother's Information  
First Name
Hebrew Name
Work Phone Number
Cell Phone Number
Email Address
Family Information  
Last Name
Address
Postal Code
Home Phone Number
Fax Number
Family History  
Is Child's Father Jewish? Yes No
Is Child's Mother Jewish? Yes No
Are there any conversions in the family? Yes No
If YES, please provide details and a copy of the documents to Yachad.
Are there any adoptions in the family? Yes No
Is anyone in your family a "Kohen" or a "Levi"? Yes No
  If yes, please explain:

Is the family a member of a Synagogue?

Yes No
  If yes, please specify:
Emergency / Medical Information
Emergency Information

In case of illness or injury of a child at school, every effort will be made to contact the parent or guardian. If parent can not be reached please contact:
Emergency Contact 1
Name
Home Phone Number
Cell Phone Number
Relationship
Emergency Contact 2
Name
Home Phone Number
Cell Phone Number
Relationship
   
Medical Information  
Family physician Name
  Phone

Does your child have any allergies or other medical condition we should be aware of? Yes No
If yes, please describe them and indicate special precautions or care needed.
Is your child up to date with vaccinations? Yes No
Medical Release
I hereby consent to the administration of Calgary Yachad Hebrew School to take whatever medical measures they deem necessary for my child in the event of a medical emergency.

I Agree


Payment/Tuition Information
Price First Child: $725 Per School Year
(Books & Snacks Included)

Second Child & Up: $650 (Books & Snacks Included)
Dates & Times Sunday 10:00 AM - 12:15 PM
   
Payment Information  
Total Amount

Payment Plan


(Please note that post-dated payments would be dated for the end of September, October, November, and December 2016
.)

Payment Method:*

** Check payments are to made payable to 'Chabad Lubavitch of Alberta'

Cardholder's Name:*

Card Number:*

Card Type:*

Expiration Date:*

We look forward to a wonderful year of learning and growth!

 

 

 

 

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Updates
Check out our new website!
www.myHebrewSchool.ca
Upcoming events
Jun. 22, 2017
Part of Torah Studies Season 3
Jun. 28, 2017
Skip the corporate lunch and have a real power lunch over Torah and delicious kosher delicacies.
Jun. 29, 2017
Part of Torah Studies Season 3
Jul. 03, 2017
Cam Gan Israel's 5777/2017 Summer Camp kicks off today with a bang!
 
Calgary Yachad Hebrew School
134 Forge Rd SE
Calgary AB T2H 0S8
 
403.281.3770 | youth@ChabadAlberta.org