Student Information

Student start Date (required)

Student First Name (required)

Student Last Name (required)

Student Hebrew Name (required)

Grade (required)
DaycareKindergarten123456789

Home Phone (required)

Cell Phone (required)

Email (required)

Address (required)

City (required)

Province/State (US & Canada) (required)

Postal/ZIP Code (required)

Student Birth Date (required)

Hebrew Birthday (required)

Gender
MaleFemale

Place of Birth (required)

Birth Certificate Number (required)

Birth Certificate File (required)

Language Spoken At Home (required)

Last School Attended (required)

School Contact Information (required)

Other Schools Attended (required)

Citizenship (Complete only if not born in Canada)
CanadianLanded ImmigrantStudent Permit

Certificate Number

Certificate File

Expiry

Parent Information (Father)

First Name

Middle Name

Last Name

Employer

Occupation

Work Phone No.

Hebrew Education

Synagogue Affiliation

Citizenship (Complete only if not born in Canada)
CanadianLanded ImmigrantStudent Permit

Certificate Number

Certificate File

Expiry

Parent Information (Mother)

First Name

Middle Name

Last Name

Employer

Occupation

Work Phone No.

Hebrew Education

Synagogue Affiliation

Citizenship (Complete only if not born in Canada)
CanadianLanded ImmigrantStudent Permit

Certificate Number

Certificate File

Expiry

Other Siblings

Name

Age

School Attending

Name

Age

School Attending

Name

Age

School Attending

Name

Age

School Attending

School Service

In a small school like ours the need for help from the parents is important in allowing us to provide the best possible programming for our students. Our family participation/school service program requires each family to contribute 18 hours of time assisting in various school programs throughout the school year. All families must articipate. There are literally dozens of service opportunities available, the PTA coordinates these activities. Please note that ALL VHA families must assist in our annual Purim Mishloach Manot Project and help deliver packages. Accompanying your registration form please submit a cheque for $450 made out to VHA postdated June 1, 2017, and please write school service in the memo line. If you fulfill your obligations this will not be cashed. Thank you for your cooperation.

School Photographs

Throughout the course of the school year, teachers and staff will take photographs in and around the school. These will most-often be used to showcase programs and events to parents in the school . At times these images will be used as part of advertising or promotional materials and social media, including the VHA website. If you would prefer that your child’s image not be included in this way, please email the VHA office at office@vhebrewacademy.com. Please include your child’s name and grade.

Society Membership

The Board of Directors encourages all VHA families to join the Vancouver Hebrew Academy Society. To be a voting member of the Society, please complete the information below.

Name (required)

Address (required)

Date (required)

Emergency Information

Student Legal First Name (required)

Student Legal Last Name (required)

Grade (required)
DaycareK123456789

Gender
MaleFemale

Medical Card No. (required)

Student Birth Date (required)

Parents Names (required)

Home Phone No. (required)

Email (required)

Address (required)

Father's Daytime No. (required)

Mother's Daytime No. (required)

ALTERNATE PERSON(S)TO CONTACT IF PARENTS CANNOT BE REACHED (if possible, within close proximity of the school)

Name (required)

Address (required)

Home Phone (required)

Daytime Phone (required)

Name (required)

Address (required)

Home Phone (required)

Daytime Phone (required)

Doctor's Name (required)

Phone No. (required)

Dentist's Name (required)

Phone No. (required)

Special Conditions, Allergies or Medical Alert (required)

The purpose of this form is to enable the parent of a student to make the school aware of any medical condition the student has that might be affected by, or, that might prevent him/her engaging in any student activity. And to provide the school with the telephone numbers where the parent and emergency contact can be reached in the event of an emergency. The information supplied on this form is to be regarded as strictly confidential and shall be made available only to appropriate persons as deemed necessary by School Administration. Please Note: The responsibility lies with the parents to advise the school if any change occurs in the medical or physical condition of the student.

(Please check each statement to complete the form)

I give my consent for the school to initiate a hospital visit in case of emergency if I cannot be reached.

I give my consent for my child to be involved in drop-in visits by the Vancouver Health Dept. Staff.

I give my consent for my child to go on a field trip within walking distance of the school.

Legal Residency of Parent - FORM A (if parents are deceased, use FORM B)

To be completed and signed by a parent or legal (court-appointed) guardian. (If legal guardian, attach copy of court order appointing you as legal guardian).

1. I am (please one):

A Canadian citizen (if not born in Canada, please attach photocopy of citizenship paper/card).A landed immigrant (attach photocopy of landed immigrant status paper)Lawfully admitted to Canada under one of the following documents. (Please mark the appropriate box below and attach photocopy of document).

If Option 3 Was Chosen
Admission as a refugee claimantA person claiming refugee status who has a letter of no objectionStudent authorization (student visa) for two or more years (or issued for one year but anticipated to be renewed for one or more additional years)Employment authorization (working permit) for two or more years (or issued for one year but anticipated to be renewed for one or more additional years)A person carrying out official duties as a diplomatic or consular official (with a foreign representative acceptance counter foil in his/her passport)Other

If Other (Document Description - Must Be Cleared With Immigration Canada)

Document Photocopy

2. I am a resident of British Columbia (please one):

YesNo, I am not a resident of British Columbia

If Yes, Provide Residency Address

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