Akiva School – École Akiva - Sibling Application Form

About Your Child

Year to enter Akiva School*

Grade to enter Akiva School*

Family name*

First name*

Hebrew name*

Gender*

Male
Female

Date of birth*

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, Max. file size: 2 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, jpeg, Max. file size: 2 MB.

Child's first language*

Other languages spoken at home

Current school / daycare*

Photo of family

Accepted file types: jpg, gif, tiff, png, pdf, jpeg, Max. file size: 2 MB.

Please upload a photo of your family

Does your child have English eligibility?*

Yes
No
I don't know

Does your child have any particular needs (physical, learning, social, behavioural)?*

Yes
No

Please provide details*

Do you give Akiva School permission to visit your child at his/her current daycare?*

Yes
No
N/A

Parent #1

Name*

Title First Last

Relationship to child*

Parent
Guardian

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home phone number

Cell phone number*

Email address*

Place of birth*

Occupation*

Parent #2

Name*

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 Country

Home phone number

Cell phone number*

Email address*

Place of birth*

Occupation*

About Your Family

Younger siblings not at Akiva

Name	Date of birth	Gender

Please upload a copy of your child's original birth certificate*

Accepted file types: jpg, pdf, tiff, tif, png, jpeg, Max. file size: 2 MB.

Consent

I confirm my child's registration at Akiva School.

Registration fee*

Price:

($50 processing fee and $200 enrolment fee)

Please note that applications submitted without payment will not be processed.