information@talmudtorahsociety.com

780-481-3377

Talmud Torah Society

6320 172 Street Edmonton, Alberta T5T 6H1

Family

Family Name
Family Name

Mother (or Guardian)
Relation to Child
First Name		Last Name
Home Phone		Cell Phone
Home Address
City
Work		Work Phone
Work Address
School		School Phone
School Address
Email Address

Mother's Citizenship Status	Canadian Citizen Permanent Resident Permanent Resident Applicant Work Visa Study Visa Visitor
Father (or Guardian)
Relation to Child
First Name		Last Name
Home Phone		Cell Phone
Home Address
City
Work		Work Phone
Work Address
School		School Phone
School Address
Email Address

Father's Citizenship Status	Canadian Citizen Permanent Resident Permanent Resident Applicant Work Visa Study Visa Visitor

Emergency Contacts

This space is intended for emergency contacts other than the parents

First Name		Last Name
Home Address
City
Home Phone		Cell Phone
Relation to Child
Authorized for Pickup

First Name		Last Name
Home Address
City
Home Phone		Cell Phone
Relation to Child
Authorized for Pickup

First Child

Personal

First Name

Last Name

Birth Date

Sex

Child Lives With

Mother Father Other

Is there a custody agreement?

Other questions, comments or notes

Enrolment

Desired Start Date

Child's Citizenship Status

Canadian Citizen
Permanent Resident
Permanent Resident Applicant
Visitor

Early Learning Centre

Grade K-9

Kinderarts--afternoon for kindergarten

Kinderarts--please indicate which days

Out of School Care

Medical

Health Care #

Physician's Name

Physician's Phone

Medical Concerns

Diet Restrictions

Allergies

Is the child's immunization up to date?

Yes No

Does your child receive medication on an ongoing basis?

Yes No

If yes, please specify

Second Child

Personal

First Name

Last Name

Birth Date

Sex

Child Lives With

Mother Father Other

Is there a custody agreement?

Other questions, comments or notes

Enrolment

Desired Start Date

Child's Citizenship Status

Canadian Citizen
Permanent Resident
Permanent Resident Applicant
Visitor

Early Learning Centre

Grade K-9

Kinderarts--afternoon for kindergarten

Kinderarts--please indicate which days

Out of School Care

Medical

Health Care #

Physician's Name

Physician's Phone

Medical Concerns

Diet Restrictions

Allergies

Is the child's immunization up to date?

Yes No

Does your child receive medication on an ongoing basis?

Yes No

If yes, please specify

Third Child

Personal

First Name

Last Name

Birth Date

Sex

Child Lives With

Mother Father Other

Is there a custody agreement?

Other questions, comments or notes

Enrolment

Desired Start Date

Child's Citizenship Status

Canadian Citizen
Permanent Resident
Permanent Resident Applicant
Visitor

Early Learning Centre

Grade K-9

Kinderarts--afternoon for kindergarten

Kinderarts--please indicate which days

Out of School Care

Medical

Health Care #

Physician's Name

Physician's Phone

Medical Concerns

Diet Restrictions

Allergies

Is the child's immunization up to date?

Yes No

Does your child receive medication on an ongoing basis?

Yes No

If yes, please specify

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