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 2021-2022 Application Fee $150.00ECC 2022-2023 Application Fee $150.00

Fri, July 30 2021
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Friday ,
JulJuly 30 , 2021

SHABBAT AT THE BEACH!
Friday, Jul 30th 5:30p to 7:00p

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Thursday ,
AugAugust 5 , 2021

Meeting of The Finance Committee
Thursday, Aug 5th 4:30p to 6:30p

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Thursday ,
AugAugust 5 , 2021

Meeting of The Executive Committee
Thursday, Aug 5th 7:00p to 9:00p

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Saturday ,
AugAugust 7 , 2021

Turning Point Dinner: Tikkun Olam
Shabbat, Aug 7th (All day)

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Saturday ,
AugAugust 7 , 2021

Shabbat Afternoon Service: Bar Mitzvah of Charlie Stohl
Shabbat, Aug 7th 4:30p to 6:00p

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Fri, July 30 2021 21 Av 5781

ECC Application Form

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Parent/Guardian Information

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