ENROLMENT



CHILD 1 INFORMATION

Surname
First Name
Hebrew name (if known)
Date of Birth (dd/mm/yyyy)
Gender
Grade (2019)
School
   
MEDICAL INFORMATION
Any medical conditions
Drug/Food allergies
Is tetanus booster up to date
Is an EPIPEN Required

 

 
CHILD 2 INFORMATION
First Name
Hebrew name (if known)
Date of Birth (dd/mm/yyyy)
Gender
Grade (2019)
School
   
MEDICAL INFORMATION
Any medical conditions
Drug/Food allergies
Is tetanus booster up to date
Is an EPIPEN required
 
MOTHERS INFORMATION
Surname
First Name
Email
Home Phone
Mobile
FATHERS INFORMATION
Surname
First Name
Email
Home Phone
Mobile

CHILDS PRIMARY ADDRESS

Street Number and Name
Postcode
 
Marital Status
Is the natural mother of the child Jewish Yes No
Are there any conversions in the family Yes No
If yes, please give further details including place of conversion  
Shul affiliation if any
 
EMERGENCY INFORMATION
Full Name
Relationship to child
Phone
Mobile
Local GP Name
Local GP Phone
 
AUTHORISATION FOR PICK UP (IF NOT PARENTS)

Full Name of Authorised Person to pick up 1 

Phone number of Authorised Person 1 

Relation to Child 

Full Name of Authorised Person to pick up 2 

Phone number of Authorised Person 2 

Relation to Child 

OPTIONAL
Special remarks  
Please put my child in the same class as
How did you hear about us
Other
 
DECLARATION OF PARENT / GUARDIAN
I hereby authorise Chabad on Carlisle-Jewish Russian Centre leaders and staff to obtain any medical care necessary for my child. I understand that in the case of emergency of any significant illness or injury, attempt will be made to contact myself when practical. I agree to pay for any cost that may occur as a result of the injury/illness. I acknowledge my child may be participate in activities within and outside the Chabad grounds. I authorise my child to participate in these activities. I hereby authorise Chabad on Carlisle-Jewish Russian Centre to photograph my child and to use the photographs at their discretion.
I agree to the above declaration.
Full Name
Date

 

 
Fees

$180 per term per child

Please note that no child will be turned away due to lack of funds. Please contact the office at 9527 6341 to discuss any financial considerations.  

 

Enrolment fee 

Lock - SecureSecure online payment 
CREDIT CARD
Visa LogoMastercard Logo

   
Card Type Visa Master Card
Name on card
Card number
Exp
Amount
Direct Debit Details
I authorise Chabad on Carlisle - Jewish Russian Centre to debit the above credit card at the start of each school term ($180 per child).