1Participant2Programs3Payment4Signature HiddenSubmission ID HiddenDebug Thank you for your registration, please complete your Program Registration below.Form Code Registration is for* Participant Sibling The FC Hebrew School provides a Hebrew and Judaic education for children with special needs. Teachers will focus on engaging the child’s sense of Jewish identity through exciting, hands-on learning. Each student will learn at their own pace with individualized curriculums. No previous Judaic instruction necessary, teachers will design curricula to meet each student’s current level and learning style.Applicant's InfoApplicant's Name* First Last Birth Date*MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberDay12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age*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 Age*Name of Parent/Guardian* Parent/Guardian Email* Parent/Guardian Cell*Is the natural mother of the child Jewish?* Yes No Were there any conversions or adoptions in the family?* Yes No Please give details of the conversion/adoption* Friends@Home Jr.Program begins on September 6, 2022 and concludes on June 16, 2023.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*SundayMondayTuesdayWednesdayThursdayFridayTime* : Hour Minutes AM PM AM/PM Second Choice*SundayMondayTuesdayWednesdayThursdayFridayTime* : 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@HomeProgramsBowlingThursdays, 6:30-8:00pmPrice: $200Deposit: $50 (non-refundable); applied to total costAide Fee: $300September 15October 27November 3December 1January 5February 2March 2April 20May 4June 1Register for Bowling Register for Bowling Bowling Price: Bowling Aide Fee Price: Joshua’s Club – Torah TimeSundays, Sundays 10am-11amPrice: $60September 18October 2November 20February 19May 28June 11Register for Joshua’s Club – Torah Time Register for Joshua’s Club – Torah Time Joshua’s Club – Torah Time Price: Football CircleSundays, 10:00 am - 11:30 amRegister for Football Circle October 2 June 4 Football Circle Price: Football Circle - QuantityTorah CircleSundays, 9:30 am - 12:00 pmPrice: $425Deposit: $50 (non-refundable); applied to total costAide Fee: $850October 23November 6November 13December 4December 18January 8January 15January 22January 29February 5February 26March 5March 12March 19April 23May 7May 21Register for Torah Circle Register for Torah Circle Torah Circle Price: Torah Circle Aide Fee Price: Torah Circle 21+Sundays, 11:30 am - 2:00 pmPrice: $510Deposit: $50 (non-refundable); applied to total costAide Fee: $850October 23November 6November 13December 4December 18January 8January 15January 22January 29February 5February 26March 5March 12March 19April 23May 7May 21Register for Torah Circle 21+ Register for Torah Circle 21+ Torah Circle 21+ Price: Torah Circle 21+ Aide Fee Price: After School FunTuesdays, 4:30 - 6:00 pmPrice: $240Deposit: $50 (non-refundable); applied to total costAide Fee: $360November 8November 15November 22November 29January 17January 24January 31February 7March 14March 21March 28April 25Register for After School Fun Register for After School Fun After School Fun Price: After School Fun Aide Fee Price: Josh’s Club NightSundays, 6:30 pm - 8:00pmPrice: $30December 11May 21Register for Josh’s Club Night Register for Josh’s Club Night Josh’s Club Night Price: Dining In #2Wednesdays, 5:00pm-6:30pmPrice: $260Deposit: $50 (non-refundable); applied to total costAide Fee: $390February 1February 8February 15March 1March 15March 22March 29April 19April 26May 3May 10May 17May 24Register for Dining In #2 Register for Dining In #2 Dining In #2 Price: Dining In #2 Aide Fee Price: Art and Cooking #2Wednesdays, 4:30pm-6:00pmPrice: $260Deposit: $50 (non-refundable); applied to total costAide Fee: $390February 1February 8February 15March 1March 15March 22March 29April 19April 26May 3May 10May 17May 24Register for Art and Cooking #2 Register for Art and Cooking #2 Art and Cooking #2 Price: Art and Cooking #2 Aide Fee Price: Skill Building #210:00am-12:00pmPrice: $280Deposit: $50 (non-refundable); applied to total costAide Fee: $560Thursday, February 2Thursday, February 9Thursday, February 16Thursday, February 23Thursday, March 2Thursday, March 9Thursday, March 16Thursday, March 23Thursday, March 30Thursday, April 20Thursday, April 27Thursday, May 4Thursday, May 11Thursday, May 18Thursday, May 25Thursday, June 1Thursday, June 8Thursday, June 15Wednesday, June 22Wednesday, June 29Register for Skill Building #2 Register for Skill Building #2 Skill Building #2 Price: Skill Building #2 Aide Fee Price: Sports #2Mondays, 4:30pm-6:00pmPrice: $220Deposit: $50 (non-refundable); applied to total costAide Fee: $330February 6February 13February 27March 13March 20March 27April 17April 24May 8May 15May 22Register for Sports #2 Register for Sports #2 Sports #2 Price: Sports #2 Aide Fee Price: Sports and Vocational Skills #2Mondays, 5:00pm-6:30pmPrice: $220Deposit: $50 (non-refundable); applied to total costAide Fee: $330February 6February 13February 27March 13March 20March 27April 17April 24May 8May 15May 22Register for Sports and Vocational Skills #2 Register for Sports and Vocational Skills #2 Sports and Vocational Skills #2 Price: Sports and Vocational Skills #2 Aide Fee Price: Culinary and Art #2Tuesdays, 11:00 am - 1:00 pm Price: $325Deposit: $50 (non-refundable); applied to total costAide Fee: $520February 7February 14February 28March 14March 21March 28April 18April 25May 9May 16May 23May 30June 6Register for Culinary and Art #2 Register for Culinary and Art #2 Culinary and Art #2 Price: Culinary and Art #2 Aide Fee Price: Joshua’s Club- Social #2Tuesdays, Tuesdays 6:30-7:30pmPrice: $70February 7February 21March 14March 28April 25May 9June 6Register for Joshua’s Club- Social #2 Register for Joshua’s Club- Social #2 Joshua’s Club- Social #2 Price: Movie NightTuesdays, 6:30-8:00pmPrice: $90Deposit: $50 (non-refundable); applied to total costFebruary 14February 28March 21April 18May 16May 30Register for Movie Night Register for Movie Night Movie Night Price: After School Fun #2Tuesdays, 4:30 - 6:00 pmPrice: $80Deposit: $50 (non-refundable); applied to total costAide Fee: $120May 2May 9May 16May 30Register for After School Fun #2 Register for After School Fun #2 After School Fun #2 Price: After School Fun #2 Aide Fee Price: FC Summer Camp Week #1Monday-Thursday: 9:30am-3:00pmPrice: $330Deposit: $50 (non-refundable); applied to total costAide Fee: $440Week #1: Monday, July 31Tuesday, August 1Wednesday, August 2Thursday, August 3Register for FC Summer Camp Week #1 Register for FC Summer Camp Week #1 FC Summer Camp Week #1 Price: FC Summer Camp Week #1 Aide Fee Price: FC Summer Camp Week #1Monday-Thursday: 9:30am-3:00pmPrice: $330Deposit: $50 (non-refundable); applied to total costPrice: $320Deposit: $100 (non-refundable); applied to total costAide Fee: $840Week #1: Monday, July 31Tuesday, August 1Wednesday, August 2Thursday, August 3Register for FC Summer Camp Week #1 Register for FC Summer Camp Week #1 FC Summer Camp Week #1 Price: FC Summer Camp Week #1 Price: FC Summer Camp Week #1 Aide Fee Price: FC Summer Camp Week #2Mon-Thurs; 9:30am-3:00pmPrice: $330Deposit: $50 (non-refundable); applied to total costAide Fee: $440Week #2: Monday, August 7Tuesday, August 8Wednesday, August 9Thursday, August 10Register for FC Summer Camp Week #2 Register for FC Summer Camp Week #2 FC Summer Camp Week #2 Price: FC Summer Camp Week #2 Aide Fee Price: FC Summer Camp Week #3Monday-Thursday: 9:30am-3:00pmPrice: $330Deposit: $50 (non-refundable); applied to total costAide Fee: $440Week #3: Monday, August 14Tuesday, August 15Wednesday, August 16Thursday, August 17Register for FC Summer Camp Week #3 Register for FC Summer Camp Week #3 FC Summer Camp Week #3 Price: FC Summer Camp Week #3 Aide Fee Price: Allies Summer CampMonday-Thursday: 9:30am-3:00pmPrice: $330Deposit: $50 (non-refundable); applied to total costAide Fee: $440Monday, August 21Tuesday, August 22Wednesday, August 23Thursday, August 24Register for Allies Summer Camp Register for Allies Summer Camp Allies Summer Camp Price: Allies Summer Camp Aide Fee Price: Allies Summer Camp 21+Monday-Thursday: 9:30am-3:00pmPrice: $330Deposit: $50 (non-refundable); applied to total costAide Fee: $440Week #1: Monday, August 21Tuesday, August 22Wednesday, August 23Thursday, August 24Register for Allies Summer Camp 21+ Register for Allies Summer Camp 21+ Allies Summer Camp 21+ Price: Allies Summer Camp 21+ Aide Fee Price: Form CalculationsDeposit Amount TotalDepositRemainder After DepositHalf PaymentQuarter PaymentProgram Summary Total ScholarshipsI would like to request a partial Scholarship I would like to request a partial Scholarship How much would you be comfortable paying?* 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{:111} Deposit $0.00 Balance $0.00 Total $0.00 Deposit Amount Total $0.00 Payment Options* Pay in full Pay in installments Payment Schedule* $0 on Apr 28 and again on Jun 28 $0 on Apr 28 and again on Jun 28, Aug 28, Oct 28 Total Charged Today$0 Total Charged Today$0We will contact you shortly regarding the scholarship amount.Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name Billing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country Payment Summary {:111}In-Person ProtocolCOVID Procedures* I have reviewed and agree to the following procedures:Hidden My child/teen/young adult will wear a mask covering the nose and mouth for duration of the program. OR My child/teen/young adult is unable to wear a mask but is fully vaccinated or has tested positive for antibodies in the last 3 month * I/my child will stay home if they or anyone in my household is not feeling well. Hidden I/my child will stay home if they or anyone in my household has been exposed to or has COVID-19. Hidden I will inform Friendship Circle if my child or myself tests positive for COVID-19. SignatureNotify 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*CommentsEmailThis field is for validation purposes and should be left unchanged. Δ
