CHS Application

Please note: Some classes are already at capacity for the 2025–26 school year. We’ll be in touch to confirm your child’s registration.
Student Information:
Students Name:*
First Name Last Name
Hebrew Name:
Birth Date:*

Month Day Year
Entering Grade:*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

What school does your child attend?*
Was your child enrolled in a Jewish day or supplementary school in 2024-2025?*

YesNo
Which one?
If you were referred to our school, who referred you?
If registering more than on child, add add additional student by clicking here:

Additional Student
Students Name:
First Name Last Name
Hebrew Name:
Birth Date:

Month Day Year
Entering Grade:
What school does your child attend?
Was your child enrolled in a Jewish day or supplementary school in 2024-2025?

YesNo
Which one?
Parent Information:
Parent 1 Name:*
First Name Last Name
Phone Number:*
E-mail:*
Parent 2 Name:
First Name Last Name
Phone Number:
E-mail:
General Information:
Was the natural mother of the child born Jewish?*

YesNo
Were there any conversions or adoptions in your family?*

YesNo
If yes please explain:
Conversion performed by Rabbi/Beth Din:
Names and ages of other siblings:
Emergency Information:
In case of emergency, when neither parent can be reached, please provide a contact who will take responsibility for your child.
Emergency Contact (other than parent):*
First Name Last Name
Home Phone:*
Cell number:
Relationship:
Child's Doctor:
Name, phone number & Address
Health card number:
Student 2 Health card number:
Allergies or Special needs:
If we, our emergency contact, or our physician (as noted on this form) cannot be reached in case of medical/surgical emergency, we hereby give permission to the physician or hospital selected by Chabad Hebrew School or its selected representative, to hospitalize, secure proper treatment for our child as named above. We understand that any cost will be our responsibility.
I Accept
Photo Release:

Chabad Hebrew School uses school photos of students in school projects, school mementos and school promotion (including print and online publications, email and social media).
I hereby give permission to Chabad Hebrew School to use photos of my children in school projects and school promotion
Payment Information:
Tuition costs are $800 per child.

Please note: Your credit card will only be charged once your application has been reviewed and approved. If you choose to pay by e-transfer, please wait to submit payment until you receive confirmation that your application has been reviewed and approved.
I would like to pay by:

Credit CardChequeE-Transfer
Please Charge me:

Today for full tution duePayment schedule
I would like to have the following payment schedule:

Payment

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Credit Card

We accept Visa, MasterCard
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Credit Card CCV:
Please make all cheques payable to Ottawa Torah Centre and mail to:
Ottawa Torah Centre
111 Lamplighters Drive
Ottawa, ON K2J 0C2
Please send E-transfers to: [email protected]

Please indicate in the notes that payment is for Hebrew School Tuition and your childs name.

Please wait to submit payment until you receive confirmation that your application has been reviewed and approved.
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Student Information:

Parent Information:

General Information:

Emergency Information:

Payment Information:

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