Register Online

We are currently accepting application forms for the 2012-2013 school year. Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss with us, please contact us.

If you would prefer to fill out this paper and mail it into our office, you print a PDF Printer Friendly Form.

Please submit a seperate form for each child. (You need only fill in unique information for additional children.)

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



 

Student Profile
First Name
Last Name
Hebrew Name
Email Address
Gender
DOB                
School
Grade Entering  
Hebrew Reading Proficiency None    Somewhat    Well
Hebrew Language
Proficiency 		None    Somewhat    Well
Previous Jewish Education Yes       No
Where?
Learning Difficulties Yes     No      
  If yes, please describe:

Parent Information
Father's Information
First Name
Hebrew Name
Work Phone #
Cell Phone #
Email Address
Mother's Information  
First Name
Hebrew Name
Work Phone #
Cell Phone #
Email Address
Family Information  
Last Name
Address
Postal Code
Home Phone #
Fax #
Family History  
Is Child's Father Jewish? Yes     No 
Is Child's Mother Jewish? Yes     No
Are there any conversions in the family? Yes     No 
If YES please copy and attach conversion documents  
Are there any adoptions in the family? Yes     No
Is anyone in your family a "Kohen" or a "Levi"? Yes     No
  If yes, please explain:

Is the family a member of a Synagogue?

Yes       No
  If yes, please specify:

Emergency / Medical Information
Emergency Information

In case of illness or injury of a child at school, every effort will be made to contact the parent or guardian. If parant can not be reached please contact:
Emergency Contact 1
Name
Phone
Cell Phone
Relationship
Emergency Contact 2 
Name
Phone
Cell Phone
Relationship
   
Medical Information  
Family physician Name
  Phone

 
Alberta Health #
Does your child have any allergies or other medical condition we should be aware of?  Yes      No
If yes, please describe them and indicate special precautions or care needed. 
Is your child up to date with vaccinations?   Yes      No
Medical Release
I hereby consent to the  administration of Gan Rivkah Hebrew School to take whatever medical measures they deem necessary for my child in the event of a medical emergency.

I Agree

Payment/Tuition Information
Tuition Information
Price

$675 Per School Year

$850 per year for group Gimmel
$45 registration fee(Snacks & Drinks Included)

$600 for Sunday Program 
Dates & Times

Thursday 4:00  - 5:30 PM

Group Gimmel: 4:00 - 6:00 PM 

Sunday: 5:00 - 6:15 PM 
   
Payment Information  
Tuition

$675
$850 (group Gimmel)                           $600 (Sunday program) 
$45 registration

Payment Plan  
Payment Method  
Card Type  
Card #  
Expiration Date   



 

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