ECC Application Form

KI Early Childhood Center Application

Student Information

Student First Name:

Student Middle Name:

Student Last Name:

Student Preferred Name:

Gender:

Student Birthdate:

Birth Country:

Inquiring for Year:

Siblings Who Have Attended KI ECC:

Age:

Parent/Guardian Information

Primary contact First Name:

Primary contact Last Name:

Primary contact Relation:

Primary contact Cell Phone:

Primary contact Email:

Secondary contact First Name:

Secondary contact Last Name:

Secondary contact Relation:

Secondary contact Cell Phone:

Secondary contact Email:

Primary Home Address:

Address Line 2

City:

State:

Zip Code:

How did you hear about KI Early Childhood Center?

I would like more information about:

Payment

* ECC Application Fee: $150.00

Please Select OneECC 2019-2020 Application Fee $150.00ECC 2020-2021 Application Fee $150.00ECC 2021-2022 Application Fee $150.00ECC 2022-2023 Application Fee $150.00

Sun, April 5 2020
11 Nisan 5780

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Monday ,
AprApril 6 , 2020

Coffee with Rabbi Hyman: Via Zoom
Monday, Apr 6th 8:00a to 9:00a

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Tuesday ,
AprApril 7 , 2020

Lunch with Rabbi Amy: Via Zoom
Tuesday, Apr 7th 12:00p to 1:00p

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Wednesday ,
AprApril 8 , 2020

NamaSTAY at Home Yoga: Via Zoom
Wednesday, Apr 8th 2:00p to 3:00p

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Wednesday ,
AprApril 8 , 2020

Seder with Rabbi Bernstein: Via Zoom
Wednesday, Apr 8th 5:00p to 6:00p

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Thursday ,
AprApril 9 , 2020

Pesach I (Building closed at noon)
Thursday, Apr 9th (All day)

MORE INFO

Sun, April 5 2020 11 Nisan 5780

ECC Application Form

Student Information

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