5786 Sunday Shorashim Program

**If you are registering more than one child , please fill out one form per child.

* Please indicate your Membership Status:

* Address

* City

* Province

* Postal Code

Home Phone (if applicable)

* Primary Cellular Number:

* Primary Email Address

Secondary Email Address

CHILD'S REGISTRATION INFORMATION:

* Full Name of Child:

* Child's Date of Birth

* Name of Parent #1:

Name of Parent #2:

Name of Parent #3:

Name of Parent #4

Please list below the names of the child's siblings and their dates of birth:

Name of Sibling #1

Date of Birth of Sibling #1

Name of Sibling #2

Date of Birth of Sibling #2

Name of Sibling #3

Date of Birth of Sibling #3

Name of Sibling #4

Date of Birth of Sibling #4

* Describe your child's familiarity with Jewish holidays, values & traditions:

Please indicate below if your child has any FOOD ALLERGIES or any DIETARY restrictions:

* Does the child have any behavioral or learning issues?

If you responded YES, please elaborate below:

PHOTO & VIDEO RELEASE CONSENT FORM:

By filling out this form, I consent to photos and videos of my child being taken during the program and used by Congregation Dorshei Emet. My child’s name and personal details will not be shared without permission.

FEES FOR MEMBERS:
6 weeks $150
18 weeks $425

FEES FOR NON-MEMBERS:
6 weeks $180
18 weeks $515

*10% SIBLING DISCOUNT CODE : SIBLING10 to be used upon payment

* Please select one of the following fee options from the dropdown list:

Total

NON-MEMBERS: Please check this box to be added to the mailing list for our weekly emailed announcements that include registration links and details for all events and services

Thu, August 28 2025 4 Elul 5785

Congregation Dorshei Emet - 18 Cleve Rd., Hampstead, QC, H3X 1A6 - 514-486-9400

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