Returning Child Application

Returning Child Application

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First Name:
Last Name:
Grade:
School Attending:
Need to update other information? Please enter below (optional):
Home Phone: Mobile Phone:
Street Address:

City: State: Zip:


Does your child exhibit any of the following behaviors (check all that apply):
Biting Cursing Grabbing Hitting
Kicking Pulling Hair Other:
Is there anything new we need to know about your child?

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11AM - 1PM.  Please check off the dates that you would like your child to join Sunday Circle/TTYA.
OCT 22
NOV 5
NOV 19
DEC 3 JAN 7
JAN 14 JAN 21 FEB 11 FEB 25 MAR 4
MAR 11 APR 15 APR 29 MAY 6 JUN 3
CHOOSE ALL OF THE ABOVE DATES        

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Bring the joys of our traditions to your child in the Hebrew School classroom Sundays 9:00 - 11:00 AM.

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Tuesdays 4:10pm-5:30pm at Congregation Levi Yitzchak, 356 N. La Brea.

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Tuesdays from 3:00 - 4:00 PM, Ages 4-18.
OCT 31
NOV 14
DEC 5
JAN 16
FEB 13 MAR 13 APR 24  MAY 8
JUN 5            

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HOLIDAY CELEBRATIONS:
Rosh Hashana Festival @ Walk4FriendshipLA Sunday, SEP 17 , 3:00pm-6:00pm
Sukkot Celebration Monday, OCT 9, 5:30pm-7:30pm
Chanukah Bash Sunday, DEC 10, 1:00pm-3:00pm
Tu B’Shvat festival Sunday, JAN 28, 1:00pm-3:00pm
Purim Celebration SUN, MAR 1, 5:00pm-7:00pm
Matzah Bakery Sunday, March 18, 12:00pm-1:00pm
SPECIAL EVENTS:
Walk4Friendship LA Sunday SEP 17, 1:30pm-6:00pm
Saturday Night Fun Saturday Night, DEC 2, 7:00pm-9:30pm

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Boys Basketball Program (for boys 10-22) - Wednesdays 6:30 - 8:00 PM @ Pressman Academy
 
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Would you like the volunteers to come and visit your home? YES NO
1st Choice Day: Time:
2nd Choice Day: Time:

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2017 Winter Camp: Monday December 25-Friday December 299:30AM-3:30PM (Friday early dismissal)

2018 Summer Camp: Monday​ August 6-Friday August 10 9:30AM-3:30PM (Friday early dismissal)


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Are there any changes in your child's medical condition/information? YES NO
If YES, please provide details:
Are there any changes in your child's insurance information? YES NO
If YES, please provide details:
Please list any allergies and/or dietary restrictions:

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Sunday Circle or TTYA: $600
Winter Camp: $450 - $90/day
Summer Camp: $450 - $90/day
Hebrew School: $1,620 (incl. $20 Siddur Fee)
Boys Basketball Program: $500 Saturday Night Fun: Free
Holiday Programs: Free Birthday Bash: Free
Friends @ Home: Free    For financial aid please email  billing@fcla.org

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Print Materials | Yes    No

Hebrew School |

Yes    No

FC Day Class Materials |
Yes    No
Social Media |
Yes    No
Pictures and Posters in FCLA |
Yes    No

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CHECK (please make payment to Friendship Circle of Los Angeles and mail to 1952 S. Robertson Blvd, Los Angeles CA 90034)
VISA MASTERCARD AMEX DISCOVER
Cardholder Name: Security Code:
Card Number: Exp. Date:
Total Charge Amount: Billing Zip Code:
Please charge my credit card in the full amount above.
Please charge my credit card $ on the first of the month over the next 10 months. (Billing department approval needed)
Please charge my credit card in two installments of $ on September 1 and December 1.
I would like to help another family participate in program with a charitable contribution of

 

No child is turned away due to lack of funds. Please email  billing@fcla.org for scholarship information. 


 

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Friendship Circle Los Angeles
1952 S Robertson Blvd, Los Angeles, CA 90034. Ph: 310.280.0955 Fax: 310.280.0974