Register Existing Students or students from the previous year for Jewish Afterschool Enrichment or Sunday Kinder Program

Parents Information

Mothers full name Mobile
Fathers full name Mobile

Have Parents information changed since last year? 
   Yes No

 If yes, please complete below  
Mothers address Email
Fathers address Email
       
Home phone    
Marital status Rabbi/officiator (if relevant)
Family Email (all communication will be via email)    



  

Child 1 Information

 
 AfterSchool Program    
 
Child 1 name D.O.B.
School Grade in 2019
    Any changes to child information?  Y  N  
Medical Conditions Drug/Food allergies
Learning Difficulties/Special Needs     Tetanus booster up to date?  
       



 

Child 2 Information

 
 AfterSchool Program 
Child 2 name D.O.B.
School Grade in 2019
    Any changes to child information?  Y    N  
Medical Conditions Drug/Food allergies
Learning Difficulties/Special Needs     Tetanus booster up to date?  
       

 

 

Emergency Information

Contact #1 Relationship to child
Phone Mobile
Contact #2 Relationship to Child
Phone Mobile
 
Local G.P. Name G.P. Phone/mobile
Special Remarks  



 

Authorizations to pick up your child

The following people are authorised to pickup my child/children. Please include all relatives/friends who may be doing pickup.
Person #1 Relationship to child
Mobile    
Person #2 Relationship to Child
Mobile    
Person #3
Relationship to Child
Mobile    
Person # 4 Relationship to Child
Mobile    

 

DECLARATION OF PARENT / GUARDIAN
 

I hereby authorise Chabad Kingston & MHC leaders and staff to obtain any medical care necessary for my child. I understand that in the case of emergency of any significant illness or injury, attempt will be made to contact myself when practical. I agree to pay for any cost that may occur as a result of the injury/illness. 
I acknowledge my child may be participate in activities within and outside the Centre's grounds. I authorise my child to participate in these activities and use the transport organised by the school. 
I hereby authorise Chabad Kingston & MHC to photograph my child and to use the photographs at their discretion.

ANNUAL PAYMENT & MULTI-YEAR ENROLMENT DECLARATION 

I hereby confirm my child’s enrolment in JAE-Jewish Afterschool Enrichment Program. 
I authorise L’Chaim Chabad to charge the Enrolment Fee on my credit card, and should I not choose to pay my fees by any other means within 14 days of each start of term, I further authorise to charge the balance to my CC. 

I fully understand that this enrolment, as part of my commitment to a long-term Jewish education at JAE, is accepted only on the basis of a minimum of one full year, and agree to pay the full annual fees accordingly. 

I further understand that as part of this long-term commitment to Jewish education, this is a Multi-Year Enrolment & Payment Form, and my child will automatically move up a level on the same day each consecutive year, and agree to be charged accordingly (fees may change upon notification). 
Mid-Year Withdrawal:In the event of a withdrawal mid-year, the Term’s remainder is payable plus a Termination Fee of $200 unless one full Term’s notice is given in writing (mail or email). Exceptions are outlined in JAE’s Policy Book. I authorise L’Chaim Chabad-Kingston to charge my credit card accordingly. 
End-Year Withdrawal: In the event of an end-year withdrawal, charges for the new year will apply unless notice is given in writing (as above) by the commencement of Term 4, and I authorise L’Chaim Chabad-Kingston to charge accordingly. I certify that the above information is true and correct, and agree to terms and conditions as per Policy Book. (Copy available from the office)

I agree to the above declaration.
Name of Parent/Gardian                                Date 



 

 

Annual JAE Enrolment & Book Fee: $50,  Term Fees  $135

 

Lock - Secure

Credit Card
Secure online PaymentMastercard Logo Visa Logo2.JPG
     
MasterCard  Visa      
Card Number Exp
Name on card Amount
 

Direct Debit

To help save administrative costs, I authorise you to debit my credit card (details listed above) in advance of each term. (Your card will be debited the first week of each term)