Apply

Student Information

Student's name

First

Last

Layout

Student’s date of birth

Place of birth

Layout

Grade applying for

School year applying for

Layout

Status in Canada

Primary language spoken at home

Household Information

Parent/Guardian 1

This parent/guardian will be the primary contact we will use for your application

Name

First

Last

Layout

Relationship to the student

Marital status

Layout

Street address

City

Layout

Province

Postal code

Layout

Email address

Home phone

Occupation

Cell phone

Work phone

Status in Canada

Parent/Guardian 1 lives with the student?

Yes
No

Parent 2/ Guardian

Name

First

Last

Layout

Relationship to the student

Marital status

P2 Street

Street address

City

P2 State

Province

Postal code

Parent 2

Email address

Home phone

Occupation

Cell phone

Work phone

Status in Canada

Parent/Guardian 2 lives with the student?

Yes
No

Parent/Guardian 2 wants to receive correspondence?

Yes
No

General information

Tell us more about your child and family

Describe the relationship you would like to have with your child’s teachers and the community

Layout

Does your child have an IEP, or private neuropsychological or psycho-educational evaluation, and/or does your child currently receive any related service such as speech therapy, special education services or counseling?

Does your child have a medical condition that requires management, medication, and/or care at school (including allergies, asthma, diabetes, seizures, etc)?

Layout

Is there anything else you would like us to know about your child?

Is your family affiliated with a congregation? If yes, which one?

Layout

Are there any conversions in the family?

Yes
No

If there are conversions, please provide details:

Layout

If applicable, legal custody agreement?

If applicable, proof of guardianship through BC Judicial process ?

Sibling information

Layout

Name

Age

School attending

Information about current school/preschool

Layout

Name of current school / preschool

School / preschool phone number

I consent for Kineret Tamim Academy to contact with the teacher/principal of my child's current school for references

Yes
No

I understand that acceptance of my child to Kineret Tamim Academy does not mean they will be able to have a Bat or Bar Mitzvah at the Chabad family Shul.

Yes

Welcome to Kineret Tamim Academy of Victoria!

To apply, please complete the application form and we will contact you about the next step. The filling of this application and administration fee does not constitute acceptance. Admissions are based on the number of spaces available and program availability.

Student Information

Household Information

Parent/Guardian 1

Parent 2/ Guardian

General information

Sibling information

Information about current school/preschool