Akiva Academy
Application Package for New Students 2016 – 2017
5776 - 5777
140 HADDON ROAD SW CALGARY, ALBERTA T2V 2Y3 TELEPHONE NUMBER: (403) 258-1312 FAX NUMBER: (403)258-3812 EMAIL ADDRESS:
[email protected] WEBSITE: www.akiva.ca
Application Policy and Procedure Policy 1. All interested parents of new applicants must meet with school administrators. 2. Parents must agree to respect the values and philosophy of the school, to abide by school policy and procedures and to support Akiva Academy's annual fundraising projects and P.T.A. initiatives. Please see Parent Handbook for details. 3. No Jewish child of relevant school age will be denied a Jewish education at Akiva Academy due to inability to pay. Application Process Please call the office at (403) 258-1312 to arrange a visit to the school. You may visit classes and arrange for your child to spend a day at Akiva. Please note that registration can also be completed on our website at www.akiva.ca.
2016 - 2017 Fee Schedule Early Registration Fees applicable until March 24, 2016
Registration Fees after March 24, 2016
Nursery - 5 mornings
$ 3825.00
$ 4080.00
Pre-Kindergarten - 5 mornings
$ 3825.00
$ 4080.00
Kindergarten - Grade 9 Kindergarten is 5 full days
$ 7650.00
$ 8160.00
**$100.00 tuition reduction for 2nd, 3rd and 4th child in K-9. This does not apply to Preschool.** To comply with Alberta Education's requirements, students entering Kindergarten must be age 5 by March 1, 2016. Early registration fees applicable only up to and including Monday, March 24, 2017. Classroom assignments will not be given out until all documents are complete. Families in need of financial assistance may request an IBP subsidy application from the school office. All requests are kept confidential. These forms must be submitted to the Calgary Jewish Federation by March 24th, 2016.
AKIVA ACADEMY Application for Admission Checklist Please fill out and sign all applicable forms in this package. Enclose the following with your application package: 1.
LEGAL DOCUMENTS: (Copies of all applicable documents) Birth Certificate/Passport Adoption Order Custody Order Canadian Citizenship Doc. Citizenship _______________________ (if other than Canadian) Permanent Resident/Landed Immigrant Doc. / Visa Immunization Record
2.
10% of total tuition - Non-refundable registration deposit, cheque payable to Akiva Academy dated March 24, 2016 to be applied against tuition.
3.
Void cheque to set up monthly pre-authorized debit. You may choose either the 10th or 25th of the month to have your account debited. Please see office for details. OR
10 postdated cheques for the remainder of tuition* - dated the 25th of the month from August 25, 2016 through May 25, 2017. Cheques are to be made payable to Akiva Academy.
4.
$50.00 - for P.T.A. Dues, per family
5.
$25.00 - for Field Trips, per student
6.
$10.00 for Homework Agenda, per student in Grades 1-9
*
PTA, Field Trips, and Homework Agenda fees may be submitted on 1 postdated cheque (August 25, 2016), payable to Akiva Academy with “school fees” in the memo line.
"Remainder of tuition" = Total tuition minus the 10% deposit.
*first child only *
AKIVA ACADEMY EMERGENCY CONTACT Will your child also be attending Daycare/After School Care? Given Name: Alberta Personal Health Number:
Student Information Surname: Date of Birth: Home Street Address: City: Postal Code: Immunization (photocopy of immunization records must be submitted to office): Up to date We choose not to/cannot immunize Allergies or other medical conditions: Mother’s Information Full Name: Home Street Address (if different from above): City: Home Phone Number: Email Address: Daytime Address: Street Address: City: Daytime Number: Father’s Information Full Name: Home Street Address (if different from above): City: Home Phone Number: Email Address: Daytime Address: Street Address: City: Daytime Number:
Child Lives with Parent?
Yes No
Postal Code: Cell Phone Number:
Postal Code:
Child Lives with Parent? Postal Code: Cell Phone Number:
Postal Code:
Emergency Contact Information (different from parents) Full Name: Relationship to Child: Home Street Address: City: Postal Code: Home Phone Number: Cell Phone Number:
Yes No
Yes No
*one per child*
AKIVA ACADEMY Application for Admission 2016 – 2017 In registering my child at Akiva Academy, I understand that Akiva Parents must agree to respect the values and philosophy of the school, to abide by school policy and procedures and to support Akiva Academy's annual fundraising projects, and P.T.A. initiatives. I agree to work on Akiva Academy fund raising projects to help defray the difference between the true cost of educating my child and the funding received by Akiva Academy for students by way of grants and tuition. I acknowledge that Akiva Academy was founded in 1980 by the Congregation House of Jacob-Mikveh Israel (HOJMI) for the purpose of providing Calgary Jewish children with a Torah education and agree to respect the Torah philosophy of the school. I understand and acknowledge that the Rabbi of the House of Jacob Mikveh Israel is the Halachic authority for Akiva Academy. I agree that all Alberta Education Grants, excluding Special Grants, are to be used to offset school programming and operating costs. I hereby make application for the admission of my child to Akiva Academy. Surname: _____________________________
Given Name: _____________________________
Hebrew Name: _____________________________ Names must be exactly as stated on birth certificate. To enter grade: _________
Male
Birthday: __ __ /__ __ /__ __ Y Y /M M/D D
Female
Name of school currently attending (if applicable): _____________________________ Siblings not attending Akiva Academy: Name:
Age:
Birthdate:
1. ___________________
_________
_________________________
2. ___________________
_________
_________________________
3. ___________________
_________
_________________________
____________________________ Parent’s Signature
____________________________ Parent’s Name (print)
________________________ Date
*one per child*
AKIVA ACADEMY Emergency/Medical Consent From time to time, a medical emergency may arise with respect to a student during school hours. In order that these emergencies may be dealt with in a manner acceptable to all, kindly provide the school with the following information: Have we your permission to: A. Call a doctor? Yes No B.
Call an ambulance or taxi if the emergency warrants it and efforts to contact a parent/guardian have proven unsuccessful? Yes No
Medical: Is your child physically challenged? If yes, check boxes: Hearing Vision Speech Movement Describe Medical Issues: ______________________________________________________________________________ ______________________________________________________________________________ ***Please include documentation if applicable***
Is there any medication taken on a regular basis? Yes No If yes, please explain: ______________________________________________________________________________ ______________________________________________________________________________ ***If prescription medication needs to be given out at school, please see the office for a Medication Application and Release Form***
Can emergency medication be taken? (EpiPen, Inhaler, etc.) Yes No If yes, please explain: ______________________________________________________________________________ ______________________________________________________________________________ ***EpiPens and Inhalers may be kept in the office for quick access in the event of an emergency***
Any other conditions Akiva should be aware of? ______________________________________________________________________________ ______________________________________________________________________________ My signature indicates that my child is aware of the arrangements we have made in the event of an emergency. ______________________ Parent’s Signature
______________________ Parent’s Name (print)
__________________ Date
*one per family*
AKIVA ACADEMY Media Release Form 2016 - 2017 We are constantly updating our advertising material which includes pictures on the Akiva website. No student names will be published in connection with any photos. Please help us by filling out the form below and returning it to school. I allow my child(ren)’s photo to be used in the advertising and promotional materials of Akiva Academy (this may include school activities, UJA promotional videos, website, newsletters, or other forms of media: Yes No Child(ren)’s Name(s): 1. ____________________________ 2. ____________________________ 3. ____________________________ 4. ____________________________ 5. ____________________________
Grade(s): _________ _________ _________ _________ _________
Annual Trip Authorization 2016 - 2017 I understand that Akiva Academy (which includes Principal, teachers and duly appointed chaperones) arranges excursions or tours which, in the opinion of the school, have definite educational, athletic, or cultural value and are an integral part of Akiva Academy’s program. I, being the parent/guardian of child(ren) listed above, consent to the student participation in any such tours or excursions arranged by Akiva Academy, and I authorize the participation by the student. It is understood that my consent and authorization is subject to advising me in writing of the following particulars of any tour or excursion at least three days prior to the intended date of the tour or excursion: 1. 2. 3. 4. 5.
Destination; Arranged supervision; Date(s) and time(s); Transportation plans; and Costs, if any.
I have the right to advise the school, by telephone, at least two days before the commencement of any particular tour or excursion, that I do not consent to the student participating in the tour or excursion, in which event my consent and authorization will be considered as withdrawn for the particular tour or excursion and the student shall not be allowed by the school to participate in such tour or excursion. This consent and authorization will be in effect for the current school year only. No child will be permitted to be involved in any class trip until this form is returned to the school.
______________________ Parent’s Signature
______________________ Parent’s Name (print)
__________________ Date
*for families new to Akiva only*
AKIVA ACADEMY Family History Page 2016 - 2017 Maternal Grandparents Names: _______________________________________________________________________ Address: ______________________________________________________________________ Phone number: _________________________________________________________________ Email Address: _________________________________________________________________ Please add email to newsletter distribution list Do not add email to newsletter distribution list
Paternal Grandparents Names: _______________________________________________________________________ Address: ______________________________________________________________________ Phone number: _________________________________________________________________ Email Address: _________________________________________________________________ Please add email to newsletter distribution list Do not add email to newsletter distribution list
Referral Please check all that apply: How did you hear about Akiva? Website Magazine/Newspaper Ad Word of Mouth (name__________________________) Other
