2021-22 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.

If you are an existing member please be sure to login first. The correct link is:
Login Link

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

Please Select OneMembership OnlyMembership and School

Rabbi's Conversion Membership

Existing Member/New MemberRabbi Conversion Member

* 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 SearchURJReferralFacebook or other Social MediaKol Ami Flyer dropped at my home

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 Volunteer CommitteeShabbat/RitualBook ClubKol Ami SoftballSocial 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 MitzvahMindfulness/YogaFamily Social EventsOffice SupportVolunteering for Kol Ami moveHebrew Speakers programAssisting with Covid-19 health protocols

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:

Please Select a Communication OptionPlease opt us out from receiving emails from Kol AmiAdult 1I want to receive [latest news, newsletters, marketing materials ] by email from Kol Ami. You can opt out from receiving email communications from us at any time . You can read about how we handle your personal information, your personal information rights and how you can contact us in our Kol Ami privacy policy on our web site.

Please send all communication to:

Please Select a Communication OptionPlease opt us out from receiving emails from Kol AmiAdult 1Adult 2BothI want to receive [latest news, newsletters, marketing materials ] by email from Kol Ami. You can opt out from receiving email communications from us at any time . You can read about how we handle your personal information, your personal information rights and how you can contact us in our Kol Ami privacy policy on our web site.

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

COMMUNITY COMMITMENT (VCS)

What is your Community Commitment?

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, in 2018, Kol Ami moved to a Voluntary Community Support (VCS) model replacing traditional membership dues. Under this model, each household contributes financially to the community to the best of their ability. The VCS model speaks to our value of inclusiveness by eliminating the discomfort of a dues relief process.

We noticed that the VCS name caused confusion among our members. We are therefore renaming our membership model to "Community Commitment". The spirit of the model is now in the name - it's your commitment to our Kol Ami community. Just as we share in all that our community has to offer, together we commit to sharing the costs of the community. We hope that your Community Commitment reflects the most generous contribution that you can afford.

Be a Sustainer!

Please become a Sustainer of the Congregation. It costs $3,600 per family to run Kol Ami. Last year, many of our families stepped up and contributed to our community at one of our sustaining levels. This year, we need your help! To sustain our operations and our amazing community, consider joining one of these Sustainer levels at Kol Ami:

Kol Ami Sustainer Levels

Shir Halleluyah (A Song of Praise): $3,600 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 Community Commitment membership 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 Community Commitment.

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 $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.

ARZA Permission

ARZA PermissionConsent

¨ By ticking this box, I agree that Kol Ami may share my email address with ARZA Canada for the purpose of receiving communications by email from ARZA Canada. Your personal information will be processed by ARZA Canada in compliance with its own privacy policy available on its website. You may unsubscribe from such communication at any time by following the instructions in each such email.

SCHOOL ENROLLMENT INFORMATION

2021-22 School Tuition and Fees:

$1050 for first child registered in grades K-7.
$950 for second and subsequent children registered in the same family in grade K-7.
$1050 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.

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

Please Select One1 Child2 Children3 Children4 Children

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

Please note that High Holy Days will be a virtual service this year. Your virtual link will be emailed to you within 24 hours prior to start of the services.

After filling in your membership form please visit our web site at:
www.kolami.ca/Registration
use this form to purchase tickets for non-members (guests).
Non Member High Holy Day Tickets

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

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 or choose to have it billed to your account so that you may make other arrangements..

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 installments, 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.

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.

Fri, May 20 2022 19 Iyar 5782