Age 13-18

Full Name*

First Name Last Name

School

Grade

Please indicate any information which may have changed since last year i.e. phone number, address, medical information etc...

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 2024-25*

Consent

(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)

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 the Friendship House fee $280)

Yes

Teen Scene Specials (fee per event)

Yes

Parent Meet Ups- parents of FC meet to discuss share and support each other once a month during Torah Circle

Yes

Moms Night Out

yes

Comments

Total

$0.00

Payment

Credit Card Check

Postal / Zip Code

Country

Return Teen Participant Registration Form

Age 13-18

Participant's Information

Parental Agreement

Programs

Payment Information

More in this section