New Student Registration Form

Page 1

Child Information

Number of children you would like to register

1

2

3

4

Child's Name

Child's Hebrew Name

Child's DOB

Child's Hebrew DOB (if not known, please indicate time of birth)

Child's Current School

Grade Entering

Please tell us about your child, strengths, weaknesses, disposition and anything else that will help us best serve your child.

Second Child's Name

Second Child's Hebrew Name

Second Child's DOB

Second Child's Hebrew DOB (if not known, please indicate time of birth)

Second Child's Current School

Grade Entering

Please tell us about your child, strengths, weaknesses, disposition and anything else that will help us best serve your child.

Third Child's Name

Third Child's Hebrew Name

Third Child's DOB

Third Child's Hebrew DOB (if not known, please indicate time of birth)

Third Child's Current School

Grade Entering

Please tell us about your child, strengths, weaknesses, disposition and anything else that will help us best serve your child.

Fourth Child's Name

Fourth Child's Hebrew Name

Fourth Child's DOB

Fourth Child's Hebrew DOB (if not known, please indicate time of birth)

Fourth Child's Current School

Grade Entering

Please tell us about your child, strengths, weaknesses, disposition and anything else that will help us best serve your child.

Page 2

To enroll your child(ren) in Intown Hebrew School, all forms must be completed and sent in to the school. Your application will not be processed without the required forms and fees.

Full payment, or the first payment in the case of a payment plan, is due at the beginning of the school year, August 1, 2025. Enrolment is considered to be for the entire scholastic year. There will be no refunds even if the child is absent due to illness, holidays, vacations and snow days, or should the parents decide to withdraw the child from the program.

In the event that tuition is not paid, IHS reserves the right to debit your Credit/Debit card, plus a $25 processing fee.

RELEASE OF INFORMATION AND PHOTOGRAPHS: Parents allow for child(ren)'s picture to be used for internal PR mailing and website where name is not given. Parents allow for child(ren)'s photograph/name released to newspapers where last name will not be given. If not, please contact us.MEDICAL RELEASE: As the parent(s) or legal guardian of the above child/ren, I/we authorize any adult acting on behalf of Intown 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, Intown Hebrew School personnel will try, but are not required, to communicate with me prior to such treatment.TRIPS AND OUTINGS RELEASE: I hereby give permission for my child to attend and participate in all trips and outings organised as part of the program by Intown Hebrew School.PRIVACY RELEASE: I hereby give permission for my child’s photographs/videos to be used in newsletters, local newspapers, Intown Hebrew School website or for promotion of our program.DISPOSITION: Parent acknowledges that Intown Hebrew School serves children who are able to function successfully in a group setting. If, in the judgment of the school's Director, the child is not able to function in a group setting, the parent may be asked to withdraw the child. In the event that the parent is request to withdraw the child, the Director will work with the parent to identify possible alternative programs suitable for the child.

By submitting and initialing this form, parents accept the terms outlined above. Both parents must initial.

Mother's Initials

Date

Father's Initials

Date

Authnet_Hidden_Fields

Page 3

Medical Information

Child's Full Name

Child's Date of Birth

Medical and Developmental History

Does your child have any medical, developmental or behavioral issue that we should know about? Describe:

Does your child take any medications on a regular basis?

YesNo

Please list all medications

Does your child have any allergies towards food or medication?

YesNo

Please list all allergies

Does your child have need for an epi-pen?

YesNo

If yes, please provide a current epi-pen and written permission to administer to Intown Hebrew School at the beginning of the school year.

Medical Emergencies

Authorization

I authorize the director or director's designee to seek appropriate medical care for my child, if necessary.

In case of emergency, when neither parent can be reached, give names of two people who will take responsibility for your child:

Emergency Contact #1:

First Name

Last Name

Phone Number

Relationship to Student

Emergency Contact #2:

First Name

Last Name

Phone Number

Relationship to Student

If parents cannot be reached and emergency medical advice is needed, permission is given to the Intown Hebrew School staff to phone my child's doctor:

Doctor

Phone Number

Address

Hospital Affiliation

In case of medical emergency requiring immediate emergency care, I authorize the paramedics to take my child to the nearest hospital if necessary. It is understood that I will hold IHS harmless for the nature and outcome of any emergency medical treatment. It is also understood that I leave the decision of what constitutes an emergency to the sole direction of the staff (please sign):

Mother's Initials

Date

Father's Initials

Date

Email

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New Student Application Form

Page 1

Page 2

Page 3

Medical Information

Medical Emergencies

In case of emergency, when neither parent can be reached, give names of two people who will take responsibility for your child:

If parents cannot be reached and emergency medical advice is needed, permission is given to the Intown Hebrew School staff to phone my child's doctor:

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