To register, you can fill out our online form below, or Download the form, (right click, and choose "Save Link As" or "Save Target As") print it, fill it out and fax it to us at 416-636-1042

JUMPIN' 4 JUDAISM
THE BETH RADOM HEBREW & JEWISH LIVING PROGRAM
STUDENT FEES
ACADEMIC YEAR 5771-72/2011-2012
JK/SK/GRADE 1
Sundays Only
$300.00
JK/SK/GRADE 1
 Sundays Only w/sibling GR 2+
$250.00
GRADE 1

Sundays & Tutorials

1/2 hour

 $495.00
GRADE 2-7
Sundays & Tutorials
$695.00
Beth Radom Synagogue Members
10% discount applies
Renewal Discount by May 13th, 2011
 $72.00
Family and Referral discounts available
* Grade 1-7
Text book and material fee
$50.00

Early Registration Discount before June 17, 2011 -
North location

Early Registration Discount before June 30, 2011* *South location only
$36.00

 

 

JUMPIN' 4 JUDAISM
THE BETH RADOM HEBREW & JEWISH LIVING PROGRAM
STUDENT REGISTRATION FORM
ACADEMIC YEAR 5771-72/2011-2012

STUDENT INFORMATION

Please Note: Required fields are marked with a red asterisk * BEFORE the field name
*Last Name *First Name Middle Name
Home Phone *Date of Birth (dd/mm/yyyy)
Address
City Province Postal Code
Students E-mail (optional)
Permission to use email for:  Office Only Share w/Teachers
Hebrew Name
Secular School Grade as of Sept. 2011
Name of secular school

J4J Sunday location preferred

PARENT/GUARDIAN INFORMATION
Last Name First Name
Last Name First Name
Home Address(if different from above)

City Province Postal Code
Parent 1 Home Phone Bus. Phone
Cell Phone E-mail
Parent 2 Home Phone Bus. Phone
Cell Phone E-mail
Student lives with:
Where did you hear about us?:

EDUCATIONAL INFORMATION:

At Beth Radom, we strive to establish an environment in which all types of learners may thrive.
Information you provide about your child's learning strengths and challenges will assist in our
efforts to accomodate and provide for those needs.
Please also provide any IPRC information if available.

My child has the following learning and/or behaviour issue (please explain):

EMERGENCY CONTACT INFORMATION
Name: Relationship:
Home Phone:     Cell Phone: 
Name: Relationship:
Home Phone:     Cell Phone: 

EMERGENCY MEDICAL INFORMATION
Doctor's Name:   Phone:
Health Card#:   Version Code:
Medical Insurance Company:
Group ID:   Plan:

Does your child have any illnesses or chronic conditions of which school personnel need to be aware
(i.e. asthma, dietary restrictions,allergies,hearing, vision, speech)?

If yes, please list and explain:
Is your child taking any medications?

If yes, please list:
In case of a medical emergency, I authorize the staff at Beth Radom Congregtion to obtain emergency
medical treatment for my child.
I/We understand and agree that in the case of emergency or injury to
(Child's name), such action will be taken and medical treatment administered as deemed necessary by the school
or its' employees. I hereby release the school, its' employees and agents from any claim or liability with the respect to the same.  I give the school
such authorization that permits any person or hospital to provide such treatment to my child as may be advisable in the circumstances,
and this shall be sufficient authority for so doing. Date: 23/02/2012
Notice to Parents/Guardians and Children - Collection and Release of Information:  Information is collected pursuant to the Education act.
Limited information may be disclosed beyond the scope of Beth Radom.  This may include the release of students' names, ages and grades,
photographs, artwork, writing or other school related work to the media for publicity, displays, newletters etc. If you do not consent to the
release of information, please inform the Director of Education in writing prior to the commencement of the school year.

All information will be held in confidence, shared only as reasonably necessary to provide a positive quality
educational experience for your child.