Application Forms

Yeshiva Darchei Torah
Application for Admission to Grade Nine

 

Part 1 can be completed online;
Part 2 must be printed, completed, and mailed to the Yeshiva;
Part 3 must be printed and given to faculty members of your son’s school for completion.

 

Application Forms are due Friday, January 18th at 12:00 PM.

Part 1

Applicant Information


Legal Given Name(s) as on Birth Certificate

Legal Last Name

Date of Birth (format dd/mm/yyyy)

Place of Birth

Date Moved to Ontario if Born Out-of-Province

Citizenship/Immigration Status

Applicant's Cell Phone

Applicants E-mail Address

Parent Information

Marital Status (please check all that apply):
 Married Separated Remarried Divorced Widowed

If parents are divorced/ seperated, custody has been awarded to:

father, mother, joint etc


Father’s Title

Father’s First Name

Father’s Last Name

Home Address Suite#

City

Postal Code

Home Telephone (format xxx-xxx-xxxx)

Father’s Occupation

Work Address

Work Telephone (format xxx-xxx-xxxx)

Cell Phone (format xxx-xxx-xxxx)

E-mail

Mother’s Title

Mother’s First Name

Mother’s Last Name (if different)

Home Address (if different) Suite #

City (if different)

Postal Code (if different)

Home Telephone (if different) (format xxx-xxx-xxxx)

Mother’s Occupation

Work Address

Work Telephone (format xxx-xxx-xxxx)

Cell Phone (format xxx-xxx-xxxx)

E-mail

Emergency Contact Information


Name of Family Doctor

Telephone of Family Doctor (format xxx-xxx-xxxx)

Address of Family Doctor

OHIP Number

Emergency Contact #1


Name

Telephone (format xxx-xxx-xxxx)

Address

Relationship

Emergency Contact #2


Name

Telephone (format xxx-xxx-xxxx)

Address

Relationship

Synagogue/Religious Affiliation


To what Synagogue does your family belong?

Who is your family’s Rabbi?

Applicant’s Siblings

Name




Age




School




Grade




Schools Applicant Attended Since Grade One

School




Year




Camps Applicant Attended

Camp




Years Attended




Youth Group Membership/Extra-Curricular Activities/Sports Leagues

Activity




Years Attended




Heath Questionnaire - To Be Completed by Parents

Is your son presently under the care of a health-care professional (e.g. physician, orthodontist, psychiatrist, psychologist, physical therapist)?
 Yes No

If yes, for what condition?

Does your son currently take any medication? Yes No

If yes, what is the drug and what are the supervision requirements?

Has your son experienced learning/behavior difficulties? Yes No

If yes please explain.

Has he ever been assessed for ADD/ADHD or learning disabilities?  Yes No

If yes, please explain.

Please send any written reports you may have together with Part 2 of the Application.

 
 

Has your son required medication in the past for behavior or learning problems (e.g. ADHD)?  Yes No

If yes, please explain.

Has your son received any of the following services – either privately or in school – within the past three years:
speech or language therapy, occupational therapy, physical therapy,
psychological services, or special education intervention?  Yes No

If yes please explain.

Are there any medical concerns that would preclude full participation in Yeshiva activities including overnight programs?
 Yes No

If yes please explain.

Has the applicant ever suffered from the following?

Respiratory

 Frequent Colds Chronic Coughs Bronchitis Asthma Pneumonia Tuberculosis

Endocrine

 Diabetes Thyroid

Cardiovascular

 Heart Trouble Rheumatic Fever Circulation Problem

Allergies

 Hay Fever Antibiotics Insect Bites Foods Other

Central Nervous System

 Headaches Dizziness Convulsions Epilepsy Fainting Ear/Eye problems

Urinary Tract

 Kidney Problems Bladder Infections

Infective

 Polio Glandular Fever Mumps Measles Rubella Chicken Pox

Gastro-Intestinal

 Bowel Problems Stomach Problems

Psychological/Psychiatric

 Hyperactivity Eating Disorders Sleep walking Others

Please enter your Full name and Email address in the fields below. By submitting this form you agree that all the information is accurate to the best of your knowledge.


Your full name: Email address:


Part 2

Press the button below to download Part 2 and mail it with the required attachments to:
Yeshiva Darchei Torah  18 Champlain Boulevard  Toronto, ON M3H 2Z1

Download Part 2: Attachments & The Parent Student Agreement

PLEASE NOTE: THIS APPLICATION WILL NOT BE CONSIDERED
COMPLETE UNTIL PART 2 HAS BEEN RECEIVED BY YESHIVA DARCHEI TORAH.

Part 3
Press the button below to download Part 3 and give the two
assessment forms to appropriate faculty members of your son’s school for completion:

Download Part 3: Confidential Assessment