ECC Pre-Nursery/Nursery Application Form 2024/2025

Welcome to Early Childhood Centre at Holy Blossom Temple!

You will be required to complete one form per child

A deposit of $1000 is required at this time to secure your spot for the 2024-2025 school year.

Once we receive the CWELCC funding for 2024, we will provide an invoice for September to December 2024.

Your deposit will be held over and reflected in your second invoice for January to June 2025.

The deposit guarantees your spot for the school year and all administrative fees.

The deposit of $1,000 will only be returned SHOULD Holy Blossom NOT BE ABLE to offer you a spot.

In the unlikely event that minimum class size is not reached by May 1 2024, Holy Blossom Temple reserves the right to cancel the class. In such cases, you will be provided a full refund of all monies paid.

Up until March 30, 2024, refunds can be requested in writing for any fees paid beyond the $1,000 deposit. Instalment payments are non-refundable as of March 31, 2024.

If you want to pay by cheque, payment must be sent to Holy Blossom Temple within 2 weeks of your application. If payment is not received it will result in the forfeiting of your child's registration.
Class placements is determined by many factors. We appreciate no requests.
Payment must be received in full by July 31, 2024.
Pre-Nursery Lunch Bunch (M-F) to 1:00 PM (child must be 2 years) Optionals add-on: $3,358.00. Separate sign-up link provided after registration

I have read the following and understood the above policies

For assistance using or completing this form, please contact Neomi Offman via email or by phone at 416-789-3291 ext. 237

Designation - ECC school 24/25

Hidden fields

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Parent/Guardian Information

The Ministry of Education requires that we have complete information for both parents/ legal guardians. Please complete this section in its entirety even if you work from home or do not work.

Parent/Guardian 1

Salutation

First Name

Last Name

Parent Guardian 1 Email Address

Address

City

Province

Postal Code

Home Phone

Mobile

Work Phone

Ext

Place of work

Business Address

Membership Status at Holy Blossom Temple

I am a memberI am not a member

Are you affiliated with another congregation?

YesNo

Congregation Name

Is there a Parent/Guardian 2?

Do Parent/Guardian 1 and 2 live in the same household?

Parent/Guardian 2

Salutation

First Name

Last Name

Parent Guardian 2 Email Address

Address

City

Province

Postal Code

Home Phone

Mobile

Work Phone

Ext

Place of work

Business Address

Do you have any specific hobbies/professional skills or interests that you could share with the children at school?

Parent/Guardian 2

Salutation

First Name

Last Name

Email Address

Home Phone

Mobile

Work Phone

Ext

Place of work

Business Address

Do you have any specific hobbies/professional skills or interests that you could share with the children at school?

Child information

First Name

Last Name

Date of Birth

Gender

Describe your child's previous school/camp experience:

Where do you intend to send your child for JK?

How many siblings does your child have?

Please list siblings name and age below:

Is your child toilet trained?

YesNoRequires helpRequires reminders

Please provide any necessary details below:

How does your child comply with limits at home?

How do you handle discipline at home?

Does your child have any difficulties with speech or motor skills? If so, please describe:

Does your child have any specific fears?

YesNo

How are they handled at home?

How does your child prefer to be comforted (or self-soothed) when upset?

How does your child handle social settings/engaging with other children?

Is there any other information regarding your child that you feel we should know?

Is there any important information regarding your family that would help us support your child (i.e. divorce, death, new sibling, new home etc.)? Please be sure to update us throughout the year as changes occur.

In addition to Judaism, there any other traditions/holidays celebrated? Please describe

Medical Information: Confidential

Physician's Full Name

Physician's Phone

Physician's Address

Under the Child Care and Early Years Act, Section 35 (1) of O. Reg. 137/2015 all children who attend a child care centre must be immunized according to Ontario's Publicly Funded Immunization Schedule. Please email Neomi Offman at noffman@holyblossom.org or send directly to Holy Blossom Temple ATTN: Neomi Offman at 1950 Bathurst Street, Toronto, ON M5P 3K9

If an exemption is required, please speak to your child care centre staff

I am able to upload a copy of my child's immunization record now

YesNo

Upload the Document Here

How is your child's general health? Please list any allergies, medical conditions, surgeries, seizures etc.:

Do you need to complete an Anaphylactic Emergency Plan for an acute/chronic medical meed?

YesNo

Please follow this link to complete the Individualized Plan For A Child With Medical Needs

Permission to Administer Medication: Confidential

Please answer the following:

Yes, my child requires medication to be administered while in schoolNo, my child does not require any medication to be administered while in school

Please provide the details below:

Name of medication

RX Number

Administering Physician

Administering Physician's number

Does the medication require refridgeration?

YesNo

Please provide instructions below including frequency and dosage details

Adult Code of Conduct

The Early Childhood Centre’s ‘Code of Conduct’ sets a clear standard of behavior that applies to all individuals involved in our community including parents or guardians, volunteers, teachers and Board members. These standards apply whether they are on Center property or at a Center sponsored event or activity.

All members of the Holy Blossom community are to be treated with dignity and respect regardless of race, creed, sexual orientation, disability or any other ground protected by the Ontario’s Human Rights Code.

All adult members have the responsibility to act as models of good behavior. Foul language (swearing, name calling, shouting) is not appropriate. Individuals engaging in such behavior will be asked to leave the premises immediately. Inappropriate behavior or harassment of any kind towards a student, parent or Holy Blossom Temple employee will result in immediate intervention up to and including the family’s expulsion from the school and/or police intervention. This type of behavior includes but is not limited to harassment or intimidation by written note, e-mail, social media, words, gestures and/or body language.

The privacy and confidentiality of our parents, guardians, employees, volunteers and students is important to us. All concerns and comments should be addressed with the teachers. Should this discussion not address your concerns, the next step is to review the situation with the Director of Early Childhood Education, Director of Education or Executive Director. Failing resolution with these parties, the matter will be referred to the appropriate member of the Board of Directors.

Gossip and public criticism are unacceptable. There should be no discussion of concerns with other parents in the school hallways, parking lot or via electronic mediums such as social media, personal blogs, email or other forms of electronic information sharing.

Any pictures taken at the school or during school events are for the private use of the family only. These pictures cannot be posted in on-line photo albums. Parents will be asked to sign a consent form regarding the use of school photos for anything other than school use.

Personal information such as addresses, e-mail addresses or phone numbers are solely for the purpose of communicating between parent and teachers and parent to parent. They are not to be used for business promotion.

Parent/Guardian 1: Full Name

I, as the Parent/Guardian 1, understood and agree to the adult code of conduct outlined above

Is there another parent or guardian?

YesNo

Parent/Guardian 1: Full Name

I, as the Parent/Guardian 2, understood and agree to the adult code of conduct outlined above

Hand Sanitizer

I hereby give permission to Holy Blossom Temple to apply 70%-90% alcohol based hand sanitizer and/or antibacterial hand wipes to my child/ren's hands.

YesNo

Please note that the use of hand sanitizer does not replace soap and water, it is used in addition to hand washing as part of hand hygiene practices and infection prevention control measures in childcare centres as mandated by Toronto Public Health.

Media and Class List Release

I hereby give permission to release photo and/or video to print/television/social media

YesNo

I hereby give permission to release my child/ren's first name with photo/video

YesNo

I hereby give permission for my information to be included on the class distribution list

YesNo

Designated Pick-Up List: Confidential

Throughout the year you may require family members, caregivers or friends to pick-up your child from school. In order to ensure that we only release your child to people with explicit consent, please complete the following:

How many people will have permission to pick up your child?

Full Name

Relationship

Primary Phone

Alternate Phone

Full Name

Relationship

Primary Phone

Alternate Phone

Full Name

Relationship

Primary Phone

Alternate Phone

Full Name

Relationship

Primary Phone

Alternate Phone

Full Name

Relationship

Primary Phone

Alternate Phone

Full Name

Relationship

Primary Phone

Alternate Phone

Full Name

Relationship

Primary Phone

Alternate Phone

Full Name

Relationship

Primary Phone

Alternate Phone

Full Name

Relationship

Primary Phone

Alternate Phone

This information will be kept in the school office and given to your child's teacher. Please notify the school if there are any changes to the names above.

Grandparent Information: Confidential

We love to include Grandparents in special events throughout the year. If you would like them included in our invites, please provide the following information.

Name:

Email:

Name:

Email:

Name:

Email:

Name:

Email:

Name:

Email:

Emergency Information: Confidential

Emergency Contacts (in the event of an emergency and you cannot be reached)

Emergency Contact #1

Full Name

Primary Phone

Alternate Phone

Home Address

City

Prov

Postal Code

Emergency Contact #2

Full Name

Primary Phone

Alternate Phone

Home Address

City

Prov

Postal Code