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Program Registration
Program Registration
1
Participant
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Programs
3
Payment
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Submission ID
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Thank you for your registration, please complete your
Program Registration
below.
Form Code
Registration is for
*
Participant
Sibling
Applicant's Info
Applicant's Name
*
First
Last
Birth Date
*
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
1
2
3
4
5
6
7
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10
11
12
13
14
15
16
17
18
19
20
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31
Year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
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2008
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1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Age
*
Applicant requires
*
Teen volunteer
Trained adult aide – There will be an additional cost for the aide per program
I will supply my own aide – no additional cost
Independent
Name of Parent/Guardian
*
First
Last
Hidden
Name of Parent/Guardian
Parent/Guardian Email
*
Parent/Guardian Cell
*
Friendship Circle is eligible to accept PerformCare funding.
Please indicate below if the participant is registered for PerformCare.
Hidden
PerformCare
*
Participant is approved with PerformCare
Participant is not approved with PerformCare
Participant is not approved with PerformCare but I am interested in finding out more
Hidden
PerformCare Choice
*
We will choose Friendship Circle as the provider for AASC (Agency After School Care)
We decline to choose Friendship Circle as our AASC provider
Hidden
PerformCare Summer Camp
We plan on choosing Friendship Circle as our summer camp provider
Friendship Circle is eligible to accept DDD funding under category of 'Goods and Services'. Please indicate below if the participant has available funding in their budget.
Hidden
DDD Funding Availability
*
Participant may have DDD funding available
Participant has DDD funding but budget is full
Participant does not have DDD funding
Friends@Home Jr.
Register for Friends@Home Jr.
Register for Friends@Home Jr.
Friends@Home Jr.
When would you like volunteers to come and visit your home?
First Choice
*
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Time
*
:
Hour
Minutes
AM
PM
AM/PM
Second Choice
*
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Time
*
:
Hour
Minutes
AM
PM
AM/PM
Would you be interested in having
*
the same volunteer
new volunteers
Please note: To help protect the safety of those involved, background checks will be required of everyone in the household who is over 18, prior to starting Friends@Home
Programs
Adult Mornings: Tuesday
Tuesdays
, 10:00 am - 1:00 pm
Price:
$3870
September 3
September 10
September 17
September 24
October 1
October 8
October 15
October 22
October 29
November 5
November 12
November 19
November 26
December 3
December 10
December 17
January 7
January 14
January 21
January 28
February 4
February 11
February 18
February 25
March 4
March 11
March 18
March 25
April 1
April 8
April 22
April 29
May 6
May 13
May 20
May 27
June 10
June 17
June 24
July 1
July 8
July 15
July 22
Register for Adult Mornings: Tuesday
Register for Adult Mornings: Tuesday
Adult Mornings: Tuesday
Price:
Adult Mornings: Wednesday
Wednesdays
, 10:00 am - 1:00 pm
Price:
$3690
September 4
September 11
September 18
September 25
October 2
October 9
October 16
October 23
October 30
November 6
November 13
November 20
December 4
December 11
December 18
January 8
January 15
January 22
January 29
February 5
February 12
February 19
February 26
March 5
March 12
March 19
March 26
April 2
April 9
April 23
April 30
May 7
May 21
May 28
June 4
June 11
June 18
July 2
July 9
July 16
July 23
Register for Adult Mornings: Wednesday
Register for Adult Mornings: Wednesday
Adult Mornings: Wednesday
Price:
Adult Mornings: Thursday
Thursdays
, 10:00 am - 1:00 pm
Price:
$3690
September 5
September 12
September 19
September 26
October 10
October 31
November 7
November 14
November 21
December 5
December 12
December 19
January 2
January 9
January 16
January 23
January 30
February 6
February 13
February 20
February 27
March 6
March 13
March 20
March 27
April 3
April 10
April 24
May 1
May 8
May 15
May 22
May 29
June 5
June 12
June 19
June 26
July 3
July 10
July 17
July 24
Register for Adult Mornings: Thursday
Register for Adult Mornings: Thursday
Adult Mornings: Thursday
Price:
Adult Torah Circle
Sundays
, 12:15 pm - 2:45 pm
Price:
$1950
Deposit:
$50 (non-refundable); applied to total cost
September 8
September 15
September 22
September 29
October 13
November 10
November 17
November 24
December 8
December 15
January 5
January 12
January 19
January 26
February 2
February 9
March 2
March 9
March 16
March 23
March 30
April 6
April 27
May 4
May 18
June 8
Register for Adult Torah Circle
Register for Adult Torah Circle
Adult Torah Circle
Price:
Torah Circle
Sundays
, 9:30 am - 12:00 pm
Price:
$1950
September 8
September 15
September 22
September 29
October 13
November 10
November 17
November 24
December 8
December 15
January 5
January 12
January 19
January 26
February 2
February 9
March 2
March 9
March 16
March 23
March 30
April 6
April 27
May 4
May 18
June 8
Register for Torah Circle
Register for Torah Circle
Torah Circle
Price:
After School: Monday
Mondays
, 4:00 - 6:00 pm
Price:
$2280
September 9
September 16
September 23
September 30
October 7
October 14
October 21
October 28
November 4
November 11
November 18
November 25
December 2
December 9
December 16
January 6
January 13
January 27
February 3
February 10
February 24
March 3
March 10
March 17
March 24
March 31
April 7
April 28
May 5
May 12
May 19
June 9
June 16
June 23
June 30
July 7
July 14
July 21
Register for After School: Monday
Register for After School: Monday
After School: Monday
Price:
Adult Afternoons: Monday
Mondays
, 5:00 - 6:30 pm
Price:
$1710
September 9
September 16
September 23
September 30
October 7
October 14
October 21
October 28
November 4
November 11
November 18
November 25
December 2
December 9
December 16
January 6
January 13
January 27
February 3
February 10
February 24
March 3
March 10
March 17
March 24
March 31
April 7
April 28
May 5
May 12
May 19
June 9
June 16
June 23
June 30
July 7
July 14
July 21
Register for Adult Afternoons: Monday
Register for Adult Afternoons: Monday
Adult Afternoons: Monday
Price:
After School: Tuesday
Tuesdays
, 4:00 - 6:00 pm
Price:
$2400
September 10
September 17
September 24
October 1
October 8
October 15
October 22
October 29
November 5
November 12
November 19
November 26
December 3
December 10
December 17
January 7
January 14
January 21
January 28
February 4
February 11
February 25
March 4
March 11
March 18
March 25
April 1
April 8
April 22
April 29
May 6
May 13
May 20
June 10
June 17
June 24
July 1
July 8
July 15
July 22
Register for After School: Tuesday
Register for After School: Tuesday
After School: Tuesday
Price:
After School: Wednesday
Wednesdays
, 4:00 - 6:00 pm
Price:
$2100
September 11
September 18
September 25
October 9
October 30
November 6
November 13
November 20
December 4
December 11
December 18
January 8
January 15
January 22
January 29
February 5
February 12
February 19
March 5
March 12
March 19
March 26
April 2
April 9
April 23
April 30
May 7
May 21
June 4
June 18
June 25
July 2
July 9
July 16
July 23
Register for After School: Wednesday
Register for After School: Wednesday
After School: Wednesday
Price:
Adult Afternoons: Wednesday
Wednesdays
, 5:00 - 6:30 pm
Price:
$1575
September 11
September 18
September 25
October 9
October 30
November 6
November 13
November 20
December 4
December 11
December 18
January 8
January 15
January 22
January 29
February 5
February 12
February 19
March 5
March 12
March 19
March 26
April 2
April 9
April 23
April 30
May 7
May 21
June 4
June 18
June 25
July 2
July 9
July 16
July 23
Register for Adult Afternoons: Wednesday
Register for Adult Afternoons: Wednesday
Adult Afternoons: Wednesday
Price:
After School: Thursday
Thursdays
, 4:00 - 6:00 pm
Price:
$2220
September 12
September 19
September 26
October 10
November 7
November 14
November 21
December 5
December 12
December 19
January 2
January 9
January 16
January 23
January 30
February 6
February 13
February 20
February 27
March 6
March 13
March 20
March 27
April 3
April 10
April 24
May 1
May 8
May 15
May 22
June 5
June 12
June 26
July 3
July 10
July 17
July 24
Register for After School: Thursday
Register for After School: Thursday
After School: Thursday
Price:
Adult Evenings: Movie Night
Tuesdays
, 6:00-7:30pm
Price:
$495
September 17
October 15
November 19
December 17
January 14
February 18
March 18
April 22
May 20
June 17
July 8
Register for Adult Evenings: Movie Night
Register for Adult Evenings: Movie Night
Adult Evenings: Movie Night
Price:
Adult Evenings: Joshuas Club
Tuesdays
, 7:00-8:00pm
October 1
November 12
December 3
January 21
February 11
March 11
April 8
May 13
June 10
July 15
Register for Adult Evenings: Joshuas Club
Register for Adult Evenings: Joshuas Club
Adult Evenings: Joshuas Club
Price:
Football Circle
Sundays
, 12:30pm-2:00pm
Register for Football Circle
October 27
November 17
June 8
Football Circle
Price:
Football Circle - Quantity
Adult Evenings: Bowling
Tuesdays
, 6:00-7:30pm
Price:
$720
November 5
November 26
December 10
January 7
January 28
February 4
February 25
March 4
March 25
April 1
April 29
May 6
May 27
June 24
July 1
July 22
Register for Adult Evenings: Bowling
Register for Adult Evenings: Bowling
Adult Evenings: Bowling
Price:
Allie’s Winter Camp
Monday & Thursday: 10:00am-3:00pm, Tuesday & Friday: 10:00am-12:30pm
Price:
$270
Monday, December 23 - 10:00am-3:00pm
Tuesday, December 24 - 10:00am-12:30pm
Thursday, December 26 - 10:00am-3:00pm
Friday, December 27 - 10:00am-12:30pm
Register for Allie’s Winter Camp
Register for Allie’s Winter Camp
Allie’s Winter Camp
Price:
Matzah Bakery
Sunday, April 6
, 12:30pm-2:00pm
Register for Matzah Bakery
Register for Matzah Bakery
Matzah Bakery
Price:
Shavuos Ice Cream Party
Monday, June 2
, 5:00pm
Register for Shavuos Ice Cream Party
Register for Shavuos Ice Cream Party
Shavuos Ice Cream Party
Price:
Form Calculations
Deposit Amount
Total
Deposit
Remainder After Deposit
Half Payment
Quarter Payment
Program Summary
Total
Scholarships
I would like to request a partial Scholarship
I would like to request a partial Scholarship
We will contact you shortly regarding the scholarship amount.
Hidden
How much would you be comfortable paying?
Hidden
I will make a team and try to raise money for the FC Walk
I will make a team and try to raise money for the FC Walk
Payment
Total
$0.00
Pay Preference
*
I will choose Friendship Circle and use PerformCare for my form of payment
I will self pay
Total Charged Today
$0
Total Charged Today
$0
Hidden
Payment Summary
{:111}
Signature
Notify on Non Attendance
*
In the event that my child is unable to attend any of the above selected programs, I will notify the Friendship Circle.
Who is filling out this form?
*
Mother
Father
Legal Guardian
Signature
*
Comments
This form is an application to register for programs at Friendship Circle. It is
not
a confirmation of program enrollment. You will receive a follow-up email when enrollment is confirmed.
Email
This field is for validation purposes and should be left unchanged.
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