Registration - Chabad Belgravia Gan

I am registering my child for*

Sunday Gan lessons (Nursery from 3 yrs old, to school Year 6)Bat Mitzvah Discovery ProgrammeBar Mitzvah Discovery Programme

Surname*

Child's first name*

Birth Date*

Month Day Year

When was your child born?*

Before sunsetAfter sunset

School attending*

Year Group Entering this academic year*

What is your child's knowledge of Hebrew Reading?*

Not applicable-My Child is a returning studentMy child has no previous Hebrew reading backgroundMy child knows some Hebrew letters.My child has had 1 year of previous experience with learning to read Hebrew.My child has had two years of previous experience with learning to read Hebrew.My child can read Hebrew.My child can read Hebrew fluently.

Home Phone*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Mother's name*

First Name Last Name

Mother's mobile*

Mother's email address*

Father's Name*

Father's Mobile*

Father's email address*

Jewish Lineage

Is the child's birth mother Jewish?*

YesNo

Has there been any conversions in the maternal line of the family?*

YesNo

If yes, please specify who the conversion is relevant to (e.g. mother, grandmother, great grandmother, great great grandmother, etc), and please provide contact information for the Synagogue and Rabbi where the conversion took place.*

Do you have a Ketuba (Jewish marriage certificate) ?*

YesNoOption 3

Have you sent us your Ketubah in the past? If not, please email us a copy at your earliest convenience. Thank you!*

YesNo

Medical Information

Is your child taking any medications?*

YesNo

Does your child have any allergies or any medical conditions?*

YesNo

If yes, please explain necessary medication and treatment*

Does your child have any special needs or learning difficulties?*

YesNo

Emergency Contact*

Phone number for Emergency Contact*

Name and Phone number of General Practitioner*

Other designated adult authorised to pick up child*

Consent

As part of our curriculum, we like to take the children out locally in small groups These trips will include visits to the local supermarket and the park or other places of interest. I give permission for my child/ren to be taken on short educational trips throughout the year. Please note: Additional consent will be sought for more involved outings and trips.*

YesNo

I consent to my child/ren travelling in a motor vehicle driven by any member of staff who accompanies the trip and is in possession of a full driving license valid for the vehicle concerned.*

YesNo

I give the staff of the Gan of Belgravia permission to take action as necessary in my absence, including taking the child to hospital or a doctor for treatment or calling the ambulance. I understand that in cases of emergency, the staff will make every effort to contact me using the emergency contact information supplied.

YesNo

From time to time we take photos of the children during their lessons to be used in relation to school or Chabad publicity. These are never distributed to any outside agency. I give permission for photos to be taken of my child and to be displayed around the school, to be used in school or Chabad publicity. I understand these are never distributed to any outside agency.*

YesNo

I give permission for photos of my child's to be shared on social media for Chabad publicity purposes.*

YesNo

I consent that my name, phone number and email address appear on a class list for my child.

YesNo

For girls attending the Bat Mitzvah Discovery program: Please contact me to arrange a meeting with Rabbi to discuss our daughter's Bat Mitzvah ceremony.

YesNo

Payment Plan:*

I will pay using this site via paypalI will be paying in full by bank transferI will be paying by direct debitI would like to discuss another payment method, please contact us to coordinate

The privacy and security of your personal data is important to us. Our Privacy Policy tells you what we do with the information you give us and about your rights. Please confirm by checking the appropriate box, that you would like to remain updated on The Gan’s programs and events by email.*

YesNo

Total

£0.00 GBP

Payment


Paypal has been selected. Payment will take place on the next page.

Gan Application Form 2022-23