Full Circle Application

Thanks for your interest in OZ’s Full Circle Preschool!

More information about our program can be found on our webpage. If you have any questions, please contact our Program Director Erika Geremia Towne at fullcircle@ohavizedek.org.

To register your child, please complete this form. The second page will allow you to pay the $75 processing fee. Note that applicants who are accepted to Full Circle and are eligible for CCFAP funding will receive a credit of their application fee on their tuition.

If you have an account already, please log in now at the upper right on the screen. It will save you time by auto-filling some form data and ensure the submission is connected to your account.

* Are you a member of OZ?

Membership is not required, though OZ members will be prioritized as spaces become available.

* Are you interested in exploring membership at OZ?

Members share interest and action in sustaining our community's cultural, spiritual, social justice and educational work.

CHILD INFORMATION

* How many children will you be registering for Full Circle Preschool?

* Child's Full Legal Name

Date of Birth

If you are expecting, please list the baby's due date.

Pronouns

Child Preferred Name / Nickname

* Tell us about your child

* Allergies, medical conditions, medicines and special needs

Please tell us in detail about any allergies, medical conditions or dietary needs/restrictions of your child. Please also list all medications that this child takes regularly. Please include if your child receives special services at this time (i.e. early intervention, speech/language therapy, occupational therapy, etc), and if you feel it would be helpful for Full Circle staff to speak with any third parties, please include the contact information.

* 2nd Child's Full Legal Name

Date of Birth

Pronouns

Child Preferred Name / Nickname

* Tell us about child 2

Allergies, medical conditions, medicines and special needs

Please tell us in detail about any allergies, medical conditions or dietary needs/restrictions of your child. Please also list all medications that this child takes regularly. Please include if your child receives special services at this time (i.e. early intervention, speech/language therapy, occupational therapy, etc), and if you feel it would be helpful for Full Circle staff to speak with any third parties, please include the contact information.

* 3rd Child's Full Legal Name

Date of Birth

Pronouns

Child Preferred Name / Nickname

* Tell us about child 3

* Allergies, medical conditions, medicines and special needs

Please tell us in detail about any allergies, medical conditions or dietary needs/restrictions of your child. Please also list all medications that this child takes regularly. Please include if your child receives special services at this time (i.e. early intervention, speech/language therapy, occupational therapy, etc), and if you feel it would be helpful for Full Circle staff to speak with any third parties, please include the contact information.

* 4th Child's Full Name

Date of Birth

Pronouns

Child Preferred Name / Nickname

* Tell us about child 4

* Allergies, medical conditions, medicines and special needs

Please tell us in detail about any allergies, medical conditions or dietary needs/restrictions of your child. Please also list all medications that this child takes regularly. Please include if your child receives special services at this time (i.e. early intervention, speech/language therapy, occupational therapy, etc), and if you feel it would be helpful for Full Circle staff to speak with any third parties, please include the contact information.

SCHEDULING

* Requested Days:

* Other Schedule

Please write it your scheduling needs and we will do our best to work with you!

* Requested Times:

FAMILY INFORMATION

PARENT / GUARDIAN 1:

* Adult 1's First Name

* Last Name

My pronouns

* Email

This is / will be your OZ online account (called Shulcloud) login email.

* Cell Phone

Home Phone

Work Phone

I prefer to be reached by

PhoneTextEmail

* Street Address Line 1

Street Address Line 2

* City

* State

* Zip Code

PARENT / GUARDIAN 2 INFORMATION:

First Name

Last Name

Pronouns

Cell Phone

Home Phone

Work Phone

Communication Preference

PhoneTextEmail

Street Address Line 1

Street Address Line 2

City

State

Zip Code

* We are proud to be a diverse and inclusive community. Please select the option that best describes your family.

Comment, if other:

* I understand that updated immunization records for my child are required for enrollment. If Full Circle is able to provide an enrollment spot, this must be submitted before the child’s start date.

I understand that updated immunization records for my child are required for enrollment. If Full Circle is able to provide an enrollment spot, this must be submitted before the child’s start date.

* Parent / Legal Guardian 1 Signature:

I verify that the information on this admission form is complete and accurate.

* Date

Parent / Legal Guardian 2 Signature (If Applicable):

* Application Fee

$75 for this applicationNote that applicants who are accepted to Full Circle and are eligible for CCFAP funding will receive a credit of their application fee on their tuition.

VOLUNTEER OPPORTUNITIES

I am interested in helping with:

Preschool Committee Member: Be a preschool family's voice in the Ohavi Zedek community!Tot ShabbatPurim PartyHelp out Full Circle In Another WayHelp out OZ In Another Way

Other volunteer ideas:

Submit below to go to the payment page.

Thanks for your interest in OZ’s Full Circle Preschool!

CHILD INFORMATION

SCHEDULING

FAMILY INFORMATION PARENT / GUARDIAN 1:

PARENT / GUARDIAN 2 INFORMATION:

VOLUNTEER OPPORTUNITIES

FAMILY INFORMATION

PARENT / GUARDIAN 1: