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Yeshivas Kayitz Registration

Home / Yeshivas Kayitz Registration

Yeshivas Kayitz Application

"*" indicates required fields

Step 1 of 4

25%

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Today's Date

MM slash DD slash YYYY

Name*

First Last

Address*

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

Phone*

Email*

Enter Email Confirm Email

Date of Birth*

MM slash DD slash YYYY

S.I.N or S.S.N*

Father's Information

Father's Name*

First Last

Place of Work

Email*

Work Phone

Cell Phone*

Mother's Information

Mother's Name*

First Last

Place of Work

Email*

Cell Phone*

Work Phone

This field is hidden when viewing the form

Please upload a SMALL picture of your son

Accepted file types: jpeg, jpg, png, Max. file size: 8 MB.

Section Break

Emergency Contact*

First Last

Emergency contact phone number*

Is the applicant up to date with all immunizations?*

Yes

No

Date of last Tetanus or DPT Vaccine?

MM slash DD slash YYYY

Does your child have any Food, Medication or Environmental Allergies? **

Food

Medication

Environmental

None

Please list and explain any allergies:

Has your child had any of the following vaccines?*

Select All

Chicken pox (Varicella)

Measles

Hepatitis B vaccine

Significant medical history (surgery, injuries, serious illness):

List any medical problems (asthma, seizures, headaches):

Are any medications required?*

Yes

No

List any medications taken regularly

In an emergency, does your child require additional assistance or medications taken in the event of an evacuation?*

Yes

No

Please describe the assistance/medication needed for evacuation.*

Insurance information

Does your child have insurance?*

Yes

No

Name of insurance company*

Name on the insurance?*

First Last

Policy Number*

Acceptance of Yeshiva rules, please enter Talmid's name*

By entering talmid's name, you agree to follow all of the Yeshiva's rules.

Security Deposit Fee

Security Deposit Authorization:*

Security Deposit Authorzation

Credit Card

Card Details

Cardholder Name

Consent*

I agree to authorize my credit card (this is not a charge, only an authorization for us to charge it if needed) to be held as a security deposit, for any damages to be charged if needed, at the discretion of the Hanholo.

Payment

Tuition Payment Options*

I would like to pay the tuition fee of $1,500 USD on this card plus a 3% transaction fee (total $1,545.00 USD)

I will be paying by check (We will contact you with details)

I will be Paying with Zelle, Paypal, Or Cashapp (We will contact you with details)

Consent*

By submitting this form I agree to have my credit card charged 1,545.00 USD on July 1st.*

By submitting this form you agree to have your card charged $1450 + 3% processing fee for the tuition fee, for a Total of $1493.50 for the summer

Name

This field is for validation purposes and should be left unchanged.

Δ

Our Contact Info

Address:
Yeshivas Lubavitch Toronto
3055 Bathurst St
Toronto, ON M6B 3B7
Canada

Phone: (416) 787-6631
Email: info@lubavitchyeshiva.com

Shabbat Times for Toronto, Ontario, Canada

Candle lighting: 8:22pm on Friday, Aug 1
Shabbat Chazon: Saturday, Aug 2
Fast begins: 8:39pm on Saturday, Aug 2
Erev Tish’a B’Av: Saturday, Aug 2
This week’s Torah portion is Parashat Devarim
Havdalah: 9:28pm on Saturday, Aug 2

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