OMJS Registration Form

Family Information

Family Name:

Choose the program

I will be paying using the following method(s): Full FeeMonthlyPost Dated ChequesE-Transfer

Student Information

First Student

Last Name: First Name: Hebrew Name: Gender: Grade: Allergies: Has an IEP: YesNo Allow Photo Use: YesNo My child can walk with the class to Hillel Lodge. (This only applies to the JCC program): YesNo

Second Student

Last Name: First Name: Hebrew Name: Gender: Grade: Allergies: Has an IEP: YesNo Allow Photo Use: YesNo My child can walk with the class to Hillel Lodge. (This only applies to the JCC program): YesNo

Third Student

Last Name: First Name: Hebrew Name: Gender: Grade: Allergies: Has an IEP: YesNo Allow Photo Use: YesNo My child can walk with the class to Hillel Lodge. (This only applies to the JCC program): YesNo

Parent Information

How did you hear about OMJS?

OMJS is a parent-run school and thrives on your participation. How would you like to help? Board MemberOther (Indicate Expertise Below) Volunteer Expertise:

Who has permission to pick up your child?

Emergency Contact Information

Last Name: First Name: Relationship: Phone Number:

Parent/Guardian 1

Name: Relationship: Address: Phone Number: Email:

Parent/Guardian 2

Name: Relationship: Address: Phone Number: Email:

Tax Receipt

Issue Tax Receipt To: Security Question: What is 3 + 4? What is 3 + 4?