BSD

Cheder RAMBAM School	Registration	Date: _________________
25 Esquimault Ave.
Ottawa, ON K2H 6Z5
Tel:  (613) 820-9484     Fax: (613) 820-0029        e-mail: info@rambam.ca

For re-registration please complete the upper part of the form until pupil's name and sign.

Please note, space is only guaranteed to be held if you include a non-refundable $500 registration fee that will be applied toward your tuition.

Preschool _______		 	Grade ______(Specify)

Pupil's Name:__________________________________________________________________________
      Last				Given Names				Hebrew Names
Birthdate: _________	Hebrew Birthdate: ______  Time of Birth: _________ AM/PM

Address _____________________________________________________________________
								Postal Code		Telephone
Father's name _____________________________________________________________
		   Last				First				Hebrew Name
Occupation ______________ Firm _______________ Telephone ____________________

Mother's Name ______________________________________________________________________________
        Maiden Name			First					Hebrew Name
Occupation ___________ Firm _______________ Telephone _______________________

Pupil's Physician ___________________________________   Telephone ______________

Pupil's Medical Problem _____________________________________________________________________________

OHIP Number: ______________________________

Individual who may be called in case parents cannot be reached:

_______________________________________________________________________________
Name					Relationship			Telephone

Pupil's Brothers and Sisters:

_______________________________________________________________________________
Name			Age		Sex		Name		Age			Sex

_______________________________________________________________________________
Name			Age		Sex		Name		Age			Sex 

Confidential Family Information
Conversion _______________________________________________________________________________

Adoption _______________________________________________________________________________

Other Information ____________________________________________________________________________

I certify all information to be complete and accurate to the best of my knowledge, and accept upon myself the responsibility of paying 
all school fees punctually.
Dated _________________________________	Signature __________________________________________________
* Please advise the school of any change of address, telephone number etc.