Application Form Please submit the information below: About Your ChildYear to enter Akiva School*20242025202620272028Family name*First name*Hebrew name*Gender* Male Female Date of birth* DD slash MM slash YYYY Place of birth*Is your child Jewish by birth?* Yes No Is your child adopted?* Yes No If yes, were they converted?* Yes No Attach child's conversion certificate*(max. 2Mb)Accepted file types: jpg, gif, tiff, png, pdf, jpeg, Max. file size: 8 MB.Is the birth mother Jewish?* No Yes, from birth Yes, from conversion Attach mother's conversion certificate(max. 2Mb)Accepted file types: jpg, gif, tiff, png, pdf, Max. file size: 2 MB.Child's first language*Other languages spoken at homeCurrent school / daycare*Do you give Akiva School permission to contact your child's current daycare?* Yes No N/A Current grade*Grade to enter*-- Choose one --Junior KindergartenKindergartenGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Photo of familyPlease upload a photo of your familyAccepted file types: jpg, gif, tiff, png, pdf, Max. file size: 2 MB.English Eligibility: All students eligible to study in English in Quebec are required to be part of the English Section of Akiva School. All students without English eligibility will be part of the Section Française of Akiva School.Does your child have English eligibility?* Yes No I don't know Copy of child’s eligibility certificateAccepted file types: jpg, gif, tiff, png, pdf, Max. file size: 2 MB.Is the child transferring from another school?* Yes No Final report card of the previous school year*Accepted file types: jpg, gif, tiff, png, pdf, Max. file size: 2 MB.Latest report card of the current year*Accepted file types: jpg, gif, tiff, png, pdf, Max. file size: 2 MB.Does your child have an IEP?* Yes No Does your child have any particular needs (physical, learning, social, behavioural)?* Yes No Please provide details*If yes, please provide us with a copy.Accepted file types: jpg, gif, tiff, png, pdf, Max. file size: 2 MB.Parent #1Name* Dr.MissMr.Mrs.Ms.Prof.Rev. Title First Last Relationship to child* Parent Guardian Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home phone numberCell phone number*Email address* Place of birth*Occupation*Business name*(enter N/A if not applicable)Child resides with this parent* Full time Part time Not at all Did you attend a Jewish school?* Yes No Please indicate your former school*Are you an alumnus of Akiva?* Yes No If yes, would you like to be added to our alumni email list?* Yes No Are you a member of a synagogue?* Yes No If yes, which one?*Parent #2Name* Dr.MissMr.Mrs.Ms.Prof.Rev. Title First Last Relationship to child* Parent Guardian Is your address the same as Parent #1?* Yes No Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home phone numberCell phone number*Email address* Place of birth*Occupation*Business name*(enter N/A if not applicable)Child resides with this parent* Full time Part time Not at all Did you attend a Jewish school?* Yes No Please indicate your former schoolAre you an alumnus of Akiva?* Yes No If yes, would you like to be added to our alumni email list?* Yes No Are you a member of a synagogue?* Yes No If yes, which one?*Parents' marital status* Married Separated Divorced Common law About Your FamilyYounger siblings not at AkivaNameDate of birthGender General Information1. Why do you wish to send your child to Akiva?* 2. Please describe any Jewish and/or general community involvement in which you and your family have participated.* 3. Is there any other information that you would like to share about your family? Please feel free to include any additional comments below.* Registration fee* Price: Please note that applications submitted without payment will not be processed. Δ
