Registration Form

Reserve your child's spot in our afterschool care or day camp program. We'll confirm your registration by email.

Child Information

Child's Full Name*

Date of Birth*

Grade*

School Name

Home Address*

Parent / Guardian 1

Full Name*

Relationship to Child*

Cell Phone*

Email Address*

Parent / Guardian 2 (if applicable)

Full Name

Relationship to Child

Cell Phone

Email Address

Emergency Contact

Name*

Phone Number*

Relationship to Child*

Authorized Pickup List

No one other than those listed may pick up my child.

Name*

Relationship

Phone Number

Medical Information

Allergies

Medical Conditions

Medications

Physician's Name

Physician's Phone

OHIP Number (optional)

Program Information

Days Attending *

Extended Care (Optional)

Monday – Thursday, 5:30 pm – 6:00 pm. Additional activities included.

Consents & Permissions

Medical Treatment Authorization: I authorize staff to obtain emergency medical treatment for my child if I cannot be reached. *

Photo & Video Permission: I give permission for photos and videos of my child to be used for program marketing and social media.

Payment Information

Program Pricing

Annual Rate$1,750 / year

Monthly Rate$175 / month

Drop-In Rate$20 / day

Extended Care (5:30–6:00 pm)$2 / min

* The above program rates do not include Extended Aftercare (5:30–6:00 pm, Mon–Thu). Extended Care is billed separately at $2 per minute.

** Pre-registration until 6:00 pm is available upon request. Please contact Danielle for pricing and information at 416-629-0655 or [email protected].

Select Payment Plan*

Credit card details are entered securely on the next step. After clicking the button below you will be taken to GoDaddy's secure payment page to complete your payment.

Late Pickup Fee Agreement: I understand that a late pickup fee will be charged after the program closing time. *

Payment Authorization: I authorize Kol Hakavod Aftercare to charge my card for program fees, late pickup fees, and outstanding balances. *

Policies Agreement & Signature

I have read and agreed to the parent handbook and program policies. *

Parent / Guardian Signature (Full Name)*

Date*

Credit card payments are processed securely via Stripe. Interac e-Transfer payments are sent to [email protected].

Questions? Contact Danielle at 416-629-0655 or [email protected]