Hebrew School payment form '24-'25 Emergency Contact Info (must not be a parent)Name First Last PhoneEmail Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Parent's Consent(Required) I agreeWith my signature bellow, I confirm that the above information is true to the best of my knowledge. I confirm the enrollment of my child in Chabad Hebrew School of Etobicoke and I permit my child to participate in all school activities, join in class/school trips on and off of school property. I allow pictures to be taken of my child and to be published online. In case of emergency, I hereby authorize Chabad Hebrew School of Etobicoke to take whatever measures the situation may call for. Permission to receive emergency care I hereby grant permission to Chabad Hebrew School of Etobicoke to take whatever steps are necessary to obtain emergency medical care if warranted. These steps may include but are not limited to the following: 1. Attempt to contact parent. 2. Attempt to contact child’s physician. 3. Attempt to contact emergency contact person. If we cannot contact the above, we will do all or any of the following: 1. Call another physician. 2. Call an ambulance. 3. Have the child taken to the nearest emergency room at a hospital by a staff member. Any expenses incurred under the circumstances will be borne by the child’s family. Chabad Hebrew School of Etobicoke will not be responsible for any incident that may occur as a result of false information given at the time of enrolment. I hereby allow Chabad Hebrew School of Etobicoke to take my child off school grounds for all trips, outings, and walks. Parent's Signature(Required) Parent's Full Name Date upon signing(Required) MM slash DD slash YYYY PaymentTuition Fee(Required) 1 Child - $750 CAD 2 Children - $1,500 CAD 3 Children - $2,250 CAD 4 Children - $3,000 CAD Total Coupon Payment Method(Required)Credit CardCheque (drop off or by orientation)Credit CardCard Details Cardholder Name Cheque should be made out to Chabad of Etobicoke 1 Child - $750 2 Children - $1,500 3 Children - $2,250 4 Children - $3,000 Δ