The Schwartz/Reisman Centre's Supplementary Schools Registration Form

Parent 1: First Name

Parent 1: Last Name

Parent 1: Email

Parent 1: Cell Number

(eg: 4171236666)

Parent 1: Home Number (eg: 4171236666)

Address (Street Name)

Apt #

City

Province

Postal Code

Parent 2: First Name

Parent 2: Last Name

Parent 2: Email

Parent 2: Cell Number (eg: 4171236666)

Parent 2: Home Number (eg: 4171236666)

Parent 2 : Address (if different from Parent 1)

(Parent 1 and 2 will be contacted in the case of emergency. In the case both parents are unavailable, please enter a third emergency contact.)

Contact Name

Contact Number

(eg: 4171236666)

Contact Relationship

Are you/your family a JCC member/s

Yes

If yes, which JCC?

Synagogue affiliation

Yes

If yes, which one?

One

Two

Three

Four

PLEASE READ AND ACCEPT OUR PROGRAM REGISTRATION POLICY

I am the parent or legal guardian of the above named minor and have legal authority to execute this informed consent agreement on his/her behalf. I understand that the activities of The Schwartz/Reisman Centre Supplementary Schools include some physical activities including dance, hands on and interactive games and recognize there are inherent risks in this activities and herby approve my child’s participation. I am aware that from time to time parents or staff members of the Schwartz/Reisman Centre or its designees photograph, audiotape, videotape or film in our classrooms. I agree and give permission to The Schwartz/Reisman Centre, associates and affiliates to collect information contained in this application and or provided subsequently for use in contacting participants and or their families. I have read and fully understood the contents of this informed consent agreement.

I Agree

I authorize The Schwartz/Reisman Centre Supplementary School to send emails to the address indicated on the registration form. I understand I can unsubscribe at any time

Yes

I agree and give permission to The Schwartz/Reisman Centre Supplementary School or its nominees, associates and affiliates to collect information contained in this application and or provided subsequently for use in contacting participants and or their families. I have read and fully understood the contents of this informed consent agreement.

I accept the above declaration: I acknowledge and understand that by checking the box below. I am electronically signing the within document, and that by doing so I acknowledge the truth and completeness of the contents thereof.

I agree to pay the fees specified in this agreement. Monthly payments will be made on or after the 15th of each month. You authorize The Schwartz/Reisman Centre to charge these dues to your bank account or credit card. You agree to notify us in writing within 10 days of any change to your bank account or credit card account.

I Agree

All registration fees and tuition fees and any charitable donations are fully tax deductible. Tax receipts will be provided by The Schwartz/Reisman Centre accounting department upon full payment. Receipts are issued once a year, usually in February for the previous year.

Please select your payment method for school fees

Visa/Mastercard

EFT (Provide a void cheque)

Please choose your payment plan

8 equal monthly installments (Sep 15, 2019 to Apr 15, 2020)

4 equal monthly installments (Sep 15, 2019 to Dec 15, 2019)

One time full payment (will be charged on Sep 15, 2019)

*** If you select EFT only the deposit will be charged to your card.

Your registration deposit is part of your tuition fees: it is not an additional fee. A $120/ per child deposit is mandatory and non-refundable before you pay for the yearly tuition. A registration deposit is required only once for the 2019-2020 year.

The Supplementary Hebrew School must be notified 4 classes prior to the last class about the cancellation in writing. In the case of a refund, the tuition fee will be based on classes attended plus four classes based on the price at the time of registration.

The $120 deposit is part of the tuition fee and charged at the time of registration

($120/student) Total Deposit Amount: $120

* Note that this card will be used to charge your future payments

First Name

Last Name

Card Type

Card Number

Expiry Date (MMYY)

CVV

Please re-check all fields before submitting.

The Schwartz/Reisman Centre's Supplementary Hebrew Schools Registration Form

Parent 1 Information *

Parent 2 Information

Emergency Contact

Family Information

How many children do you want to register?

Student One Information

Other Information

School preferences

Photo Release *

Consent for out of class activities*

Photo Release *

Consent for out of class activities*

Student Two Information

Other Information

School preferences

Photo Release *

Consent for out of class activities*

Photo Release *

Consent for out of class activities*

Student Three Information

Other Information

School preferences

Photo Release *

Consent for out of class activities*

Photo Release *

Consent for out of class activities*

Student Four Information

Other Information

School preferences

Photo Release *

Consent for out of class activities*

Photo Release *

Consent for out of class activities*

Registration Policy *

E-mail Consent *

Accept Declaration *

Charitable Tax Receipts

Payment Options

Refund Policy for J. Roots and Kachol Lavan

Deposit Details:

($120/student) Total Deposit Amount: $120

Credit Card Details:

Parent 1 Information
*

Photo Release
*

Consent for out of class activities
*

Photo Release
*

Consent for out of class activities
*

Photo Release
*

Consent for out of class activities
*

Photo Release
*

Consent for out of class activities
*

Photo Release
*

Consent for out of class activities
*

Photo Release
*

Consent for out of class activities
*

Photo Release
*

Consent for out of class activities
*

Photo Release
*

Consent for out of class activities
*

Registration Policy
*

E-mail Consent
*

Accept Declaration
*