1Participant2Programs3Payment CompanyThis field is for validation purposes and should be left unchanged.This field is hidden when viewing the formSubmission IDDebugThank you for your registration, please complete your Program Registration below.Form CodeRegistration is for* Participant Sibling Applicant's InfoApplicant's Name* First Last Birth Date*MonthMonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberDayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age*This field is hidden when viewing the formApplicant 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 Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Name of Parent/Guardian* First Last This field is hidden when viewing the formName of Parent/GuardianParent/Guardian Email* Parent/Guardian Cell*Friendship Circle is eligible to accept PerformCare funding. Please indicate below if the participant is registered for PerformCare. This field is hidden when viewing the formPerformCare* 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 This field is hidden when viewing the formPerformCare 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 This field is hidden when viewing the formPerformCare 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. This field is hidden when viewing the formDDD 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.I'm interested in Friends@Home Jr. I'm interested in 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@HomeProgramsFC Summer Camp Week #1 2026Monday-Thursday: 9:30am-3:30pm & Friday; 9:30am-2:00pmPrice: $1390Week #1: Monday, August 3 - 9:30am-3:30pmTuesday, August 4 - 9:30am-3:30pmWednesday, August 5 - 9:30am-3:30pmThursday, August 6 - 9:30am-3:30pmFriday, August 7 - 9:30am-2:00pmI'm interested in FC Summer Camp Week #1 2026 I'm interested in FC Summer Camp Week #1 2026 FC Summer Camp Week #1 2026 Price: FC Summer Camp Week #2 2026Mon-Thurs; 9:30am-3:30pm. Friday; 9:30am-2:00pmPrice: $1390Week #2: Monday, August 10 - 9:30am-3:30pmTuesday, August 11 - 9:30am-3:30pmWednesday, August 12 - 9:30am-3:30pmThursday, August 13 - 9:30am-3:30pmFriday, August 14 - 9:30am-2:00pmI'm interested in FC Summer Camp Week #2 2026 I'm interested in FC Summer Camp Week #2 2026 FC Summer Camp Week #2 2026 Price: FC Summer Camp Week #3 2026Monday-Thursday: 9:30am-3:30pm & Friday; 9:30am-2:00pmPrice: $1390Week #3: Monday, August 17 - 9:30am-3:30pmTuesday, August 18 - 9:30am-3:30pmWednesday, August 19 - 9:30am-3:30pmThursday, August 20 - 9:30am-3:30pmFriday, August 21 - 9:30am-2:00pmI'm interested in FC Summer Camp Week #3 2026 I'm interested in FC Summer Camp Week #3 2026 FC Summer Camp Week #3 2026 Price: FC Adults Summer Experience 2026Monday-Thursday: 10:00am-2:30pm & Friday 10:00-2:00pmPrice: $1155Monday, August 24 - 10:00am-2:30pmTuesday, August 25 - 10:00am-2:30pmWednesday, August 26 - 10:00am-2:30pmThursday, August 27 - 10:00am-2:30pmFriday, August 28 - 10:00am-2:00pmI'm interested in FC Adults Summer Experience 2026 I'm interested in FC Adults Summer Experience 2026 FC Adults Summer Experience 2026 Price: Adult Mornings: TuesdayTuesdays, 10:00 am - 1:00 pm Price: $3420Aide Fee: $2850September 8September 15September 22September 29October 6October 13October 20October 27November 3November 10November 17November 24December 1December 8December 15December 22January 5January 12January 19January 26February 2February 9February 16February 23March 2March 9March 16March 30April 6April 13May 4May 11May 18May 25June 1June 8June 15June 22June 29July 6July 13July 20July 27I'm interested in Adult Mornings: Tuesday I'm interested in Adult Mornings: Tuesday Adult Mornings: Tuesday Price: Adult Mornings: Tuesday Aide Fee Price: After School: TuesdayTuesdays, 4:00 - 6:00 pmPrice: $2220Aide Fee: $2035September 8September 15September 22October 6October 13October 20October 27November 3November 10November 17November 24December 1December 15December 22January 5January 12January 19January 26February 2February 9February 16February 23March 2March 9March 16March 30April 6April 13May 4May 11May 18May 25June 1June 8June 15June 22June 29July 6July 13July 20July 27I'm interested in After School: Tuesday I'm interested in After School: Tuesday After School: Tuesday Price: After School: Tuesday Aide Fee Price: Adult Evenings: Joshuas ClubTuesdays, 7:00-8:00pmSeptember 8October 6November 3December 1January 5February 2March 2April 13May 11June 1July 6I'm interested in Adult Evenings: Joshuas Club I'm interested in Adult Evenings: Joshuas Club Adult Evenings: Joshuas Club Price: Adult Mornings: WednesdayWednesdays, 10:00 am - 1:00 pm Price: $3240Aide Fee: $2700September 9September 16September 23September 30October 7October 14October 21October 28November 4November 11November 18November 25December 2December 9December 16January 6January 13January 20January 27February 3February 10February 17March 3March 10March 17March 24March 31April 7April 14May 5May 12May 26June 2June 9June 16June 23June 30July 7July 14July 21July 28I'm interested in Adult Mornings: Wednesday I'm interested in Adult Mornings: Wednesday Adult Mornings: Wednesday Price: Adult Mornings: Wednesday Aide Fee Price: Adult Afternoons: WednesdayWednesdays, 5:00 - 6:30 pmPrice: $1275Price: $1530September 9September 16September 23October 7October 14October 21October 28November 4November 11November 18December 2December 16January 6January 13January 20January 27February 3February 10February 17March 3March 10March 17March 24March 31April 7April 14May 5May 12May 26June 2June 16June 23June 30July 7July 14July 21July 28I'm interested in Adult Afternoons: Wednesday I'm interested in Adult Afternoons: Wednesday Adult Afternoons: Wednesday Price: Adult Afternoons: Wednesday Price: After School: WednesdayWednesdays, 4:00 - 6:00 pmPrice: $1870Price: $2040September 9September 16September 23October 7October 14October 21October 28November 4November 11November 18December 2December 16January 6January 13January 20January 27February 3February 10February 17March 3March 10March 17March 24March 31April 7April 14May 5May 12May 26June 2June 16June 23June 30July 7July 14July 21July 28I'm interested in After School: Wednesday I'm interested in After School: Wednesday After School: Wednesday Price: After School: Wednesday Price: Adult Mornings: ThursdayThursdays, 10:00 am - 1:00 pm Price: $3510Aide Fee: $2925September 10September 17September 24October 1October 8October 15October 22October 29November 12November 19December 3December 10December 17January 7January 14January 21January 28February 4February 11February 18February 25March 4March 11March 18March 25April 1April 8April 15May 6May 13May 20May 27June 3June 10June 17June 24July 1July 8July 15July 22July 29I'm interested in Adult Mornings: Thursday I'm interested in Adult Mornings: Thursday Adult Mornings: Thursday Price: Adult Mornings: Thursday Aide Fee Price: After School: ThursdayThursdays, 4:00 - 6:00 pmPrice: $2280Aide Fee: $1900September 10September 17September 24October 8October 15October 22October 29November 12November 19December 3December 17January 7January 14January 21January 28February 4February 11February 18February 25March 4March 11March 18March 25April 1April 8April 15May 6May 13May 20May 27June 3June 17June 24July 8July 15July 22July 29I'm interested in After School: Thursday I'm interested in After School: Thursday After School: Thursday Price: After School: Thursday Aide Fee Price: Adult Mornings: MondayMondays, 10:00 am - 1:00 pm Price: $3420Aide Fee: $2850September 14September 28October 5October 19October 26November 2November 9November 16November 23November 30December 7December 14December 21January 4January 11January 25February 1February 8February 22March 1March 8March 15March 22March 29April 5April 12April 19May 3May 10May 17May 24June 7June 14June 21June 28July 12July 19July 26I'm interested in Adult Mornings: Monday I'm interested in Adult Mornings: Monday Adult Mornings: Monday Price: Adult Mornings: Monday Aide Fee Price: Adult Afternoons: MondayMondays, 5:00 - 6:30 pmPrice: $1665Aide Fee: $1387.50September 14October 5October 19October 26November 2November 9November 16November 23November 30December 14December 21January 4January 11January 25February 1February 8February 22March 1March 8March 15March 22March 29April 5April 12April 19May 3May 10May 17May 24June 7June 14June 21June 28July 5July 12July 19July 26I'm interested in Adult Afternoons: Monday I'm interested in Adult Afternoons: Monday Adult Afternoons: Monday Price: Adult Afternoons: Monday Aide Fee Price: After School: MondayMondays, 4:00 - 6:00 pmPrice: $2217Price: $2220Aide Fee: $2030September 14October 5October 19October 26November 2November 9November 16November 23November 30December 14December 21January 4January 11January 25February 1February 8February 22March 1March 8March 15March 22March 29April 5April 12April 19May 3May 10May 17May 24June 7June 14June 21June 28July 5July 12July 19July 26I'm interested in After School: Monday I'm interested in After School: Monday After School: Monday Price: After School: Monday Price: After School: Monday Aide Fee Price: Adult Evenings: BowlingTuesdays, 6:00-7:30pmPrice: $765Aide Fee: $637.50September 15October 13October 27November 10November 24December 15January 12January 26February 9February 23March 9March 30April 6May 4May 25June 8June 22June 29July 13July 27I'm interested in Adult Evenings: Bowling I'm interested in Adult Evenings: Bowling Adult Evenings: Bowling Price: Adult Evenings: Bowling Aide Fee Price: Adult Evenings: Movie NightTuesdays, 6:00-7:30pmPrice: $405Aide Fee: $337.50September 22October 20November 17December 22January 19February 16March 16May 18June 15July 20I'm interested in Adult Evenings: Movie Night I'm interested in Adult Evenings: Movie Night Adult Evenings: Movie Night Price: Adult Evenings: Movie Night Aide Fee Price: JR Dinner in the SukkahTuesday, September 29, 6:00pmI'm interested in JR Dinner in the Sukkah I'm interested in JR Dinner in the Sukkah JR Dinner in the Sukkah Price: Adult Torah CircleSundays, 12:15 pm - 2:45 pmPrice: $1950Price: $2175Aide Fee: $1812.50October 11October 18November 1November 8November 15November 22December 6December 13December 20January 10January 17January 24January 31February 7February 21February 28March 7March 14March 21March 28April 4April 11April 18May 2May 16May 23June 6I'm interested in Adult Torah Circle I'm interested in Adult Torah Circle Adult Torah Circle Price: Adult Torah Circle Price: Adult Torah Circle Aide Fee Price: Torah CircleSundays, 9:30 am - 12:00 pmPrice: $1950Price: $2175Aide Fee: $2175October 11October 18November 1November 8November 15November 22December 6December 13December 20January 10January 17January 24January 31February 7February 21February 28March 7March 14March 21March 28April 4April 11April 18May 2May 16May 23June 6I'm interested in Torah Circle I'm interested in Torah Circle Torah Circle Price: Torah Circle Price: Torah Circle Aide Fee Price: Football CircleSundays, 11:00am-1:00pmI'm interested in Football Circle October 18 May 23 Football Circle Price: Football Circle - QuantityFC Summer Camp Week #1 2027Monday-Thursday: 9:30am-3:00pm & Friday; 9:30am-2:00pmPrice: $1200Week #1: Monday, August 2 - 9:30am-3:00pmTuesday, August 3 - 9:30am-3:00pmWednesday, August 4 - 9:30am-3:00pmThursday, August 5 - 9:30am-3:00pmFriday, August 6 - 9:30am-2:00pmI'm interested in FC Summer Camp Week #1 2027 I'm interested in FC Summer Camp Week #1 2027 FC Summer Camp Week #1 2027 Price: FC Summer Camp Week #2 2027Mon-Thurs; 9:30am-3:00pm & Friday; 9:30am-2:00pmPrice: $1200Week #2: Monday, August 9 - 9:30am-3:00pmTuesday, August 10 - 9:30am-3:00pmWednesday, August 11 - 9:30am-3:00pmThursday, August 12 - 9:30am-3:00pmFriday, August 13 - 9:30am-2:00pmI'm interested in FC Summer Camp Week #2 2027 I'm interested in FC Summer Camp Week #2 2027 FC Summer Camp Week #2 2027 Price: FC Summer Camp Week #3 2027Monday-Thursday: 9:30am-3:00pm & Friday; 9:30am-2:00pmPrice: $1200Week #3: Monday, August 16 - 9:30am-3:00pmTuesday, August 17 - 9:30am-3:00pmWednesday, August 18 - 9:30am-3:00pmThursday, August 19 - 9:30am-3:00pmFriday, August 20 - 9:30am-2:00pmI'm interested in FC Summer Camp Week #3 2027 I'm interested in FC Summer Camp Week #3 2027 FC Summer Camp Week #3 2027 Price: FC Adults Summer Experience 202710:00am-2:30pmMonday, August 23 - 10:00am-2:30pmTuesday, August 24 - 10:00am-2:30pmWednesday, August 25 - 10:00am-2:30pmThursday, August 26 - 10:00am-2:30pmFriday, August 27 - 10:00am-2:30pmI'm interested in FC Adults Summer Experience 2027 I'm interested in FC Adults Summer Experience 2027 FC Adults Summer Experience 2027 Price: Form CalculationsDeposit AmountTotalDepositRemainder After DepositHalf PaymentQuarter PaymentProgram Summary TotalScholarshipsScholarship I would like to request a partial Scholarship This field is hidden when viewing the formI would like to request a partial Scholarship I would like to request a partial Scholarship We will contact you shortly regarding the scholarship amount.This field is hidden when viewing the formHow much would you be comfortable paying?This field is hidden when viewing the formI 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 PaymentTotal $0.00 Pay Preference - Under 21* I will choose Friendship Circle and use PerformCare for my form of payment I will self pay Pay Preference - Over 21* I will use my DDD budget I will self pay Total Charged Today$0 Total Charged Today$0This field is hidden when viewing the formPayment Summary{:111}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*CommentsThis 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. Δ