Returning Students Registration Form


Student Profile
Family Name
Name of Child #1
Name of Child #2
Name of Child #3
Parent Information

If any parental contact information has changed in the past 12 months
please share current info:

Emergency Information
Emergency Contact 1
Emergency Contact 2
Doctor's Name
Doctor's Phone Number
Medical Insurance Company
Policy Number

Have there been any changes in medical or any other pertinent information in the past 12 months? Yes No

If yes, please list changes

Tuition Agreement
Tuition for the year, per child: $825 (750 +75 registration fee)
Early Bird Discount before June 30th: $800
BUS PICKUP- From Cedervale, Humewood (possibly other schools) $125
 Please check box with your choice for method of payment.
Prepayment in full before September.
10 monthly installments (Sept - June) in the form of 10 postdated checks
Method of payment:
Credit Card
Please mail checks to Chabad of Midtown Hebrew School, 1344 Bathurst St., Toronto ON M5R 3H7
Payment Information
Card Type Card Number
Exp Date CVV
Amount to Charge Billing Zip
Family Name  
Child 1 Cost: $800 (before June 30):
Child 2 Cost: $800 (before June 30):
Child 3 Cost: $800 (before June 30):
Total Cost:    

As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad Hebrew School to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Chabad Hebrew School personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all school activities, join in class and school trips on and beyond school properties.

I Accept

Name: Initials: Date:

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