We are now accepting application forms for the 2011-2012 school year.
Looking forward to a wonderful year of learning and growth.     

Student Profile
 
Name
Last
Hebrew Name
DOB            
School
Grade Entering
Hebrew Reading Proficiency None    Somewhat    Well
Previous Jewish Education Yes            No
Where?

Parent Information
 
Father's Name
Phone
Mother's Name
Phone
Address
City
Province
Postal Code
Email Address

Emergency Information
 
Emergency Contact 1
Phone
Emergency Contact 2
Phone

CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of?  If yes, please describe them and indicate special precautions or care needed. 




As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Aleph Champ Niagara 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, Aleph Champ Niagara 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 and allow my child to be photographed while participating in Aleph Champ activities and that these pictures may be used for marketing purposes.

I Accept   

Name:     Initials:

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