1Participant2PerformCare3Programs4Payment and Signature HiddenSubmission ID Debug Thank you for your registration, please complete your Program Registration below.Form Code Registration is for* Participant Sibling Applicant's InfoApplicant's Name* First Last Birth Date*MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberDay12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age*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 HiddenName 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. 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 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 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. 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*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@HomeProgramsAdult Mornings – TuesdayTuesdays, 10:00 am - 1:00 pm Price: $3870Deposit: $50 (non-refundable); applied to total costSeptember 3September 10September 17September 24October 1October 8October 15October 22October 29November 5November 12November 19November 26December 3December 10December 17January 7January 14January 21January 28February 4February 11February 18February 25March 4March 11March 18March 25April 1April 8April 22April 29May 6May 13May 20May 27June 10June 17June 24July 1July 8July 15July 22Register for Adult Mornings – Tuesday Register for Adult Mornings – Tuesday Adult Mornings – Tuesday Price: Adult Evenings – BowlingTuesdays, 6:00-7:30pmPrice: $810Deposit: $50 (non-refundable); applied to total costSeptember 3September 24October 8October 22November 5November 26December 10January 21February 4February 25March 4March 25April 1April 29May 20May 27July 1July 22Register for Adult Evenings – Bowling Register for Adult Evenings – Bowling Adult Evenings – Bowling Price: Torah Circle 21+Sundays, 12:00 pm - 2:30 pmPrice: $1950Deposit: $50 (non-refundable); applied to total costSeptember 8September 15September 22September 29October 13November 10November 17November 24December 8December 15January 5January 12January 19January 26February 2February 9March 2March 9March 16March 23March 30April 6April 27May 4May 18June 8Register for Torah Circle 21+ Register for Torah Circle 21+ Torah Circle 21+ Price: Torah CircleSundays, 9:30 am - 12:00 pmPrice: $1950Deposit: $50 (non-refundable); applied to total costSeptember 8September 15September 22September 29October 13November 10November 17November 24December 8December 15January 5January 12January 19January 26February 2February 9March 2March 9March 16March 23March 30April 6April 27May 4May 18June 8Register for Torah Circle Register for Torah Circle Torah Circle Price: After School – MondayMondays, 4:00 - 6:00 pmPrice: $2220Deposit: $50 (non-refundable); applied to total costSeptember 9September 16September 23September 30October 7October 14October 21October 28November 4November 11November 18November 25December 2December 9December 16January 6January 13January 27February 3February 10February 24March 3March 10March 17March 24March 31April 7April 28May 5May 12May 19June 16June 23June 30July 7July 14July 21Register for After School – Monday Register for After School – Monday After School – Monday Price: After School – TuesdayTuesdays, 4:00 - 6:00 pmPrice: $2400Deposit: $50 (non-refundable); applied to total costSeptember 10September 17September 24October 1October 8October 15October 22October 29November 5November 12November 19November 26December 3December 10December 17January 7January 14January 21January 28February 4February 11February 25March 4March 11March 18March 25April 1April 8April 22April 29May 6May 13May 20June 10June 17June 24July 1July 8July 15July 22Register for After School – Tuesday Register for After School – Tuesday After School – Tuesday Price: After School – WednesdayWednesdays, 4:00 - 6:00 pmPrice: $2100Deposit: $50 (non-refundable); applied to total costSeptember 11September 18September 25October 9October 30November 6November 13November 20December 4December 11December 18January 8January 15January 22January 29February 5February 12February 19March 5March 12March 19March 26April 2April 9April 23April 30May 7May 21June 4June 18June 25July 2July 9July 16July 23Register for After School – Wednesday Register for After School – Wednesday After School – Wednesday 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 HiddenHow much would you be comfortable paying? HiddenI 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 HiddenPaymentTotal $0.00 Total Charged Today$0 Total Charged Today$0We will contact you shortly regarding the scholarship amount.HiddenPayment 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.NameThis field is for validation purposes and should be left unchanged. Δ