2020-21 Registration and Renewal Form

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Whether you are renewing your membership or joining us for the first time, we are delighted you have chosen to be part of the Kol Ami community this year. We hope that you will find membership an enriching experience and encourage you to explore the diverse opportunities for Jewish expression that Kol Ami offers.

Please call upon us whenever we can assist you in becoming part of our Kol Ami community. Please call our office at 905.709.2620 if you have any questions or need assistance in filling out this application. All information in this application will be treated confidentially.

Welcome to Kol Ami. Please tell us what we can help you with.

Please Select OneMembership OnlyMembership and School

Rabbii's Conversion Membership

How many Adults are part of this Membership or School Application

Please Select One1 Adult2 Adults

How did you hear about us?

Please Select OneReturning MemberRoad SignWeb SearchURJReferral

Who should we thank?

PERSONAL INFORMATION

Adult 1 Information

First Name

Middle Name

Last Name

Correspondence Email Address

Birth date

Occupation

Hobbies

Hebrew Name

Father's Hebrew Name

Mother's Hebrew Name

Community Involvement

Please indicate any areas of talent/interest by checking the appropriate box or boxes.

Adult EducationChoirFundraisingHigh Holy Day PlanningHebrew School Committee of Volunteering in SchoolShabbat/RitualBook ClubKol Ami BaseballSocial ActionAdult Social GroupService LeadershipInterfaith CommitteeJoin a Chavurah ( a small group of members/families that get together monthly for fun, social, or family events.)Programming for Active RetireesLGBTQ+ EventsSmall Business Networking GroupSHTYX, Kol Ami's Rock BandAdult Bar/Bat MitzvahMindfullness/YogaFamily Social Events

Adult 2 Information

First Name

Middle Name

Last Name

Correspondence Email Address

Date of Birth

Occupation

Hobbies/Interests

Hebrew Name

Father's Hebrew Name

Mother's Hebrew Name

Please send all communication to:

Adult 1Please opt us out from receiving emails from Kol Ami

Please send all communication to:

Adult 1Adult 2BothPlease opt us out from receiving emails from Kol Ami

How many children will be included in your Membership/Registration?

noneOne ChildTwo ChildrenThree ChildrenFour Children

Please include the names of all your children under the age of 25 as they are included in your membership. Children 26 and older must apply for membership on their own.

Child 1

First Name

Middle Name

Last Name

Hebrew Name

Is this child 18 years old or over?

YesNo

Date of Birth

Name of School Entering in the Fall

Grade Entering in the Fall

Child 2

First Name

Middle Name

Last Name

Hebrew Name

Is this child 18 years old or over?

YesNo

Date of Birth

Name of School Entering in the Fall

Grade Entering in the Fall

Child 3

Child 3 First Name

Child 3 Middle Name

Child 3 Last Name

Hebrew Name

Is this child 18 years old or over?

YesNo

Date of Birth

Name of School Entering in the Fall

Grade Entering in the Fall

Child 4

First Name

Middle Name

Last Name

Hebrew Name

Is this child 18 years old or over?

YesNo

Date of Birth

Name of School Entering in the Fall

Grade Entering in the Fall

VOLUNTARY COMMUNITY SUPPORT

What is Voluntary Community Support

Kol Ami is a Kehilah Kedoshah – a holy, inclusive community whose members rely on one another and which strives to help people of all ages and backgrounds find joy, meaning and support through Judaism. In line with these values, Kol Ami moved to a Voluntary Community Support (VCS) model replacing traditional membership dues.

VCS is voluntary support of your congregation - to the best of your ability. Just as we share in all that our community has to offer, together as a community we share the cost of supporting the congregation. Members are asked to “stretch” to support Kol Ami at the most generous level that they can.

Be a Sustainer!

Please become a Sustainer of the Congregation. It costs $3,100 per family to run Kol Ami. Last year, 27 of our families gave at one of our Sustaining levels. This is not enough! This year, we need you to join one of these Sustainer levels at Kol Ami:

If every member family were to Step Up their monthly contribution by an additional $54 per month ($648 for the year), Kol Ami would be well on its way to sustainability. Please dig deeply and contribute as generously as you can!

Kol Ami Sustainer Levels

Shir Halleluyah (A Song of Praise): $3,100 and up ($260/month)

Havah Nashirah (Let Us Sing): $5,000 and up ($417/month)

Shir Chadash (A New Song): $7500 and up ($625/month)

Shiru L’Adonai (Sing unto God): $10,000 and up ($833/month)

If you have any questions about Voluntary Community Support please contact the Kol Ami office, email Dana Glickman or contact Membership Chair Ed Yudin.

What amount do you wish to contribute to Kol Ami this year?

Gifts can be divided into as many as 12 monthly installments***
Please enter the amount you wish to contribute this year for your Voluntary Community Support.

ARZA CANADA SUPPORT

ARZA Canada is the Zionist Organization of the Canadian Reform Movement. ARZA Canada works to increase Israel engagement and helps to create an Israel that is both Jewish and democratic. ARZA Canada partners with the growing Israel Reform Movement which is working toward the goals of democracy, equality, and pluralism. ARZA Canada membership dues are $5 per adult 18 years of age and older. Kol Ami members are strongly encouraged to be members of ARZA Canada. We have added added $5 per adult and any child between the ages of 18-25 to your membership in addition to your Voluntary Community Support contribution.

If you have any questions or would NOT like to be an ARZA Canada member, please contact the office.

SCHOOL ENROLLMENT INFORMATION

How many children are being enrolled in Kol Ami's School Program?

Please Select One1 Child2 Children3 Children4 Children

SCHOOL FEES

2020-21 School Tuition and Fees:

$950 for first child registered in grades K-7.
$850 for second and subsequent children registered in the same family in grade K-7.
$950 B'nai Mitzvah fee for children in grade 7 (in addition to tuition. Covers tutoring and other expenses.)
$360 fee for child registered in Madrichim program (grades 8-10).

If you require subsidy for the Kol Ami School, you must apply through UJA Community Scholarships.

Name of Student 1

Name of Student 2

Name of Student 3

Name of Student 4

Grade Entering in the Fall - Student 1

Please Select OneJKSKGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8Grade 9Grade 10

Grade Entering in the Fall - Student 2

Please Select OneJKSKGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8Grade 9Grade 10

Grade Entering in the Fall - Student 3

Please Select OneJKSKGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8Grade 9Grade 10

Grade Entering in the Fall - Student 4

Please Select OneJKSKGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8Grade 9Grade 10

EDUCATIONAL CONSIDERATIONS

In the text box(es) below, please note if your child(ren) receive(s) any education services, such as IEP, Adaptive Equipment, Special Education, Outside Tutoring, Physical / Occupational Therapy, One-on-on Aide*, Behavioral Resource, Gifted/Talented, etc.

Student 1

Student 2

Student 3

Student 4

DIAGNOSES OR ASSESSMENTS

In the text box(es) below, please note if your child(ren) is/are diagnosed as having, or is being assessed for any of the following: ADHD, Anxiety, Autism Spectrum Disorder, Conduct/Oppositional Disorder, Developmental/Cognitive Delay, Depression, Emotional/Behavioral Disorder, Hearing Disorder, Learning Disability, Obsessive Compulsive Disorder (OCD), Speech/Language Disability, Physical Disability, Cerebral Palsy, Tourette Syndrome, Visual Impairment, Other.

Student 1

Student 2

Student 3

Student 4

MEDICAL INFORMATION

Student 1 OHIP Number

Student 2 OHIP Number

Student 3 OHIP Number

Student 4 OHIP Number

Are student 1 immunizations current?

NoYes

Are student 2 immunizations current?

NoYes

Are student 3 immunizations current?

NoYes

Are student 4 immunizations current?

NoYes

Does student 1 take medication on a regular basis?

NoYes

Does student 2 take medication on a regular basis?

NoYes

Does student 3 take medication on a regular basis?

NoYes

Does student 4 take medication on a regular basis?

NoYes

Does student 1 have a medical condition that could result in a medical emergency?

AsthmaDiabetesSiezure DisorderLife Threatening Allergy (Epipen)Other

Does student 2 have a medical condition that could result in a medical emergency?

AsthmaDiabetesSiezure DisorderLife Threatening Allergy (Epipen)Other

Does student 3 have a medical condition that could result in a medical emergency?

AsthmaDiabetesSiezure DisorderLife Threatening Allergy (Epipen)Other

Does student 4 have a medical condition that could result in a medical emergency?

AsthmaDiabetesSiezure DisorderLife Threatening Allergy (Epipen)Other

Student 1 - Please enter any additional information regarding medical conditions (please include triggers, severity, and treatment)

Student 2 - Please enter any additional information regarding medical conditions (please include triggers, severity, and treatment)

Student 3 - Please enter any additional information regarding medical conditions (please include triggers, severity, and treatment)

Student 4 - Please enter any additional information regarding medical conditions (please include triggers, severity, and treatment)

Nut Awareness Policy

We have a number of students who suffer from severe nut allergies. Even trace amounts of a problem food can cause a life-threatening allergic reaction.

Please help us maintain a safe community by keeping all nuts and nut products out of the school (peanuts, walnuts, almonds and all other tree nuts). Even those foods labelled with “may contain" or "traces of" in the list of ingredients can be harmful. We appreciate your assistance in making the school safe for every student.

While we strive to be a nut aware facility, we cannot guarantee that your child will not come into contact with products containing nuts. Every reasonable effort will be made to provide a nut aware environment at Kol Ami. Our Staff, members, and students cannot be held responsible. The ultimate responsibility lies with the parents and student to ensure their safety. It is therefore important that if your child has serious allergies, inform us upon registration, and provide any necessary instructions and an EpiPen.

Who is allowed to pick up your child(ren) from school?

Please enter one or more names of people you authorize to pick up your child(ren) after school.

EMERGENCY CONTACT INFORMATION

Please list two people that we may contact in the event we are unable to reach a parent in an emergency.

Emergency Contact 1
First Name

Emergency Contact 1
Last Name

Emergency Contact 1 Relationship

e.g. grandparent, aunt, family friend, etc.

Emergency Contact 1 Phone

Emergency Contact 2
First Name

Emergency Contact
Last Name

Emergency Contact 2 Relationship

e.g. grandparent, aunt, family friend, etc.

Emergency Contact 2 Phone

SCHOOL DISCLAIMER

If we or our emergency contact cannot be reached cannot be reached in the event of a medical emergency, we hereby give permission to the physician or hospital selected by the school or its selected representative, to hospitalize and/or secure proper treatment for our child(ren) named above. We understand that any costs incurred will be our responsibility.

From time to time, limited information about your child(ren) may be disclosed beyond the scope of Temple Kol Ami. This may include the release of students' ages, grades, images, artwork, writing or other school related work to the media for publicity, displays, newsletters, etc. If you do not consent to the release of information, you must notify the temple office in writing, prior to the start of the school year.

Kol Ami has a Privacy Policy, Screening and Hiring procedures, and Supervision/Intervention policies that are available from the office upon request.

Subtotal - Tuition and Fees

YARZHEIT INFORMATION

You may verify your yarzheit information in the My Account section of the website, which can be found by clicking on your name at the top right of any page on the website. (You will need to be logged in to do this. If you are not logged in, you will see a Login button at the top right of every page.)

If you do not wish to do this online you may contact the temple office to review and update this information.

DEDICATED DONATIONS TO KOL AMI FUNDS

If you wish to make an additional dedicated donation to Kol Ami funds ( outside of your Voluntary Community Support), enter the amount into the box under that fund. Thank you for your generous support!

General Fund

General support of Kol Ami programming and expenses

Religious School Fund

Materials, scholarships and other support of our Religious School.

Adult Education Fund

Funds our congregation's extensive adult learning.

Annie Berlin Music Fund

For choir and other musical needs.

Bernstein Family Scholar in Residence Fund

Supports our popular annual Scholar in Residence program.

Chesed Fund

Provides for needs of families experiencing loss or illness.

Community Shabbat Dinner Fund

Supports our community Shabbat dinners.

Rabbi's Discretionary Fund

Used for tzedakah, chesed and to support programs at the rabbi's discretion.

Sacred Text Fund

Provides for repair/maintenance of Torah scrolls and purchase of prayer books.

Marleine Kay-Levin Social Action Fund

Supports our Tikkun Olam (Repairing the World) efforts.

Vanek Book Fund

Supports our efforts to build a congregational library.

Wechsler Youth Fund

Jewish camping and youth group scholarships, and supporting educational experiences for our youth.

NON-MEMBER HIGH HOLY DAY TICKETS

High Holy Day tickets will be issued for each member of your family. Please use this form to purchase tickets for non-members (guests).

Non-member tickets may be purchased for friends and family of our members:

ADULTS (13 yrs and older) - $250
CHILDREN (under 13 yrs old) - $54

Note: Kol Ami's Family HH services (9am, one hour, geared toward families with children) is open to the public for a donation. Please contact the office for more information.

Select the number of adult tickets you wish to purchase.

Select the number of child tickets you wish to purchase.

High Holy Day ADULT Ticket Holders

Enter the names of each ADULT you are purchasing tickets for. Please separate each name with a comma.

High Holy Day ADULT Ticket Holders

Enter the names of each CHILD you are purchasing tickets for. Please separate each name with a comma.

ONEG SPONSORSHIPS

Celebrate a simcha, remember a loved one and support Kol Ami by sponsoring a Friday Night Oneg. Please select the dates you would like to sponsor below. The cost to sponsor an Oneg is $72.

You will be contacted to confirm the dates that you have selected.

Oneg Shabbat Dates

September 11, 2020October 30, 2020November 13, 2020November 27, 2020December 25, 2020

Oneg Shabbat Dates

January 8, 2021January 29, 2021February 5, 2021February 19, 2021April 30, 2021

Oneg Shabbat Dates

May 14, 2021May 28, 2021June 25, 2021

TOTAL:

Includes Voluntary Community Support, ARZA membership, and any donations, High Holy Day tickets, and/or school registration fees.

PLANNED GIVING

I would like information on including Kol Ami in my will or estate

ADMINISTRATION

On the next page you will be presented with payment options.

You may make your payment by credit card via Authorize.net, or choose to have it billed to your account so that you may make other arrangements, such as paying by cheque.

If you choose to pay by credit card, you may also specify if you wish to pay in full via a single payment, or via 2-12 monthly instalments, right on the payment page.

IMPORTANT NOTE: If you wish to have your contribution billed to your account and wish to establish a multiple payment arrangement, please select Bill To My Account on the next page, and DO NOT change the payment amount/frequency. You will then need to email admin@kolami.ca to make your alternate payment arrangements. We apologize for the inconvenience and are working to address this limitation.

NOTE: NSF cheques are subject to a $36 charge.

By completing this form, I am affirming that all the information entered here is accurate and up to date, to the best of my knowledge.

Please click the 'Save and Continue' button below.

Tue, 20 October 2020 2 Cheshvan 5781