Registration Form
September 2012 - May 2013
Kesher school will take place on Wednesdays, 4:30-6pm in St. Matthews United Church at 729 St. Clair West. Submitting this form secures a spot in the Kesher classroom for your child, and ensures that on completion the family will pay the deposit which is non-refundable.
* the deposit is 25% of the total fee ($172.50 – not including Walking School Bus fees).
Please note the 10% sibling discount applies to the second child registered from a family only
Child's Name:_________________________________________
Child's Birthdate:____________________________ Grade 2012/2013: ________
Name of Child's day school: ___________________________________________
Address with Postal Code:_____________________________________________
Contact Parents Name: ______________________________________________
Second Parents Name: _______________________________________________
Contact Parents Phone (home/work/cell):___________________________________
Email Address: ______________________________________________________
Will this child be participating in the Walking School Bus? _________
In Emergency, please call: ____________________________ at ______________
Child's Health Card Number: __________________________________________
Doctor's Name and Phone Number: _____________________________________
Does your child have any allergies or special needs?
_________________________________________________________________
Is there any other information that would help your child enjoy this program to its fullest?
___________________________________________________________________________________________________________________________________.
Contact Parent Signature: _________________________ Date: ______________
Please address the deposit and all Kesher payments to “Hashomer Hatzair”
Registration should be mailed to:
Mika Gang, Kesher School Principal
926 Briar Hill Ave.
Toronto Ont.
M6B 1M2
Or scan and email to: [email protected] by July 30th 2012.
*Please note the location of the Kesher School is St. Matthew’s United Church, 729 St. Clair ave.