Printed fromFCMD.org

ב"ה

Families Register Returning Participant

Return Junior Participant Registration Form

Age 3-12

Participant's Information
Full Name
First NameLast Name
School
Grade
Please indicate any information which may have changed since last year i.e. phone number, address, medical information etc...
Parental Agreement
If my child participates in the Friends at Home program, I agree that a parent/guardian will be present in the home to supervise them.*
Consent
I permit my child's photo to be used for publicity purposes.
Consent
Where applicable, I permit my child to be transported by the Friendship Circle to or from activities.
Consent
I hereby release the Friendship Circle, its providers and administrators from ALL liability resulting from any incident which affects the health, welfare or safety of my child while participating in a Friendship Circle program for the year 2022-23.*
Consent
Programs
(Please note that if you require financial assistance for any of the programs, please don't hesitate to contact us and we will gladly accomodate you.)
I would like my child to participate in the following programs:
Birthday Club - one Sunday a month (no fee) recommended until age 14- depending on the venue
Yes
Friends at Home - Once a week throughout the school year. We will be in touch with you about timing. (No Fee)
Yes
Holiday Programs - seasonal
Yes
Torah Circle - two Sundays a month from 1:30-3:00pm at Friendship House Tent in Potomac- (fee $280)
Yes
Parent Meet Ups- parents of FC meet to discuss share and support each other once a month during Torah Circle
Yes
Comments
Payment Information
Total
$0.00

Payment

Credit Card Check

Postal / Zip Code

Country

Should be Empty:

This page uses TLS encryption to keep your data secure.

More in this section

Return Teen Participant Registration Form

Return YAD Registration Form