1Participant2PerformCare3Programs4Payment and Signature HiddenSubmission ID HiddenDebug 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*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 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@HomeProgramsCulinary and Art #1Tuesdays, 10:00 am - 1:00 pm Price: $1350Deposit: $50 (non-refundable); applied to total costAide Fee: $1050September 5September 12September 19September 26October 3October 10October 17October 24November 7November 14November 21November 28December 5December 12December 19Register for Culinary and Art #1 Register for Culinary and Art #1 Culinary and Art #1 Price: Culinary and Art #1 Aide Fee Price: Social Club #1Thursdays, 10:00am-1:00pmPrice: $1350Deposit: $50 (non-refundable); applied to total costAide Fee: $1050September 7September 14September 21September 28October 5October 12October 19October 26November 2November 9November 16November 30December 7December 14December 21Register for Social Club #1 Register for Social Club #1 Social Club #1 Price: Social Club #1 Aide Fee Price: Bowling #1Thursdays, 6:30-8:00pmPrice: $180Deposit: $50 (non-refundable); applied to total costAide Fee: $120September 7October 12November 2December 21Register for Bowling #1 Register for Bowling #1 Bowling #1 Price: Bowling #1 Aide Fee Price: Sports #1Mondays, 4:30pm-6:00pmPrice: $495Deposit: $50 (non-refundable); applied to total costAide Fee: $330September 11September 18October 16October 23October 30November 6November 13November 20November 27December 4December 18Register for Sports #1 Register for Sports #1 Sports #1 Price: Sports #1 Aide Fee Price: Sports #1 Early Drop offMondays, 3:30pm-4:30pmPrice: $330Deposit: $50 (non-refundable); applied to total costAide Fee: $330September 11September 18October 16October 23October 30November 6November 13November 20November 27December 4December 18Register for Sports #1 Early Drop off Register for Sports #1 Early Drop off Sports #1 Early Drop off Price: Sports #1 Early Drop off Aide Fee Price: Sports and Social Time #1Mondays, 5:00pm-6:30pmPrice: $495Deposit: $50 (non-refundable); applied to total costAide Fee: $440September 11September 18October 16October 23October 30November 6November 13November 20November 27December 4December 18Register for Sports and Social Time #1 Register for Sports and Social Time #1 Sports and Social Time #1 Price: Sports and Social Time #1 Aide Fee Price: Joshua’s Club Night7:00-8:00pmTuesday, September 12Tuesday, October 24Tuesday, November 21Tuesday, December 5Tuesday, January 9Tuesday, February 6Tuesday, March 12Thursday, April 18Tuesday, May 21Tuesday, June 4Register for Joshua’s Club Night Register for Joshua’s Club Night Joshua’s Club Night Price: After School Fun #1Tuesdays, 4:30 - 6:00 pmPrice: $495Deposit: $50 (non-refundable); applied to total costAide Fee: $440September 12September 19September 26October 17October 24November 7November 14November 21November 28December 5December 19Register for After School Fun #1 Register for After School Fun #1 After School Fun #1 Price: After School Fun #1 Aide Fee Price: After School Fun #1 Early Drop offTuesdays, 3:30pm-4:30pmPrice: $330Deposit: $50 (non-refundable); applied to total costAide Fee: $330September 12September 19September 26October 17October 24November 7November 14November 21November 28December 5December 19Register for After School Fun #1 Early Drop off Register for After School Fun #1 Early Drop off After School Fun #1 Early Drop off Price: After School Fun #1 Early Drop off Aide Fee Price: Art and Cooking #1Wednesdays, 4:30pm-6:00pmPrice: $540Deposit: $50 (non-refundable); applied to total costAide Fee: $480September 13September 20September 27October 11October 18October 25November 1November 8November 15November 29December 6December 20Register for Art and Cooking #1 Register for Art and Cooking #1 Art and Cooking #1 Price: Art and Cooking #1 Aide Fee Price: Art and Cooking #1 Early Drop offWednesdays, 3:30pm-4:30pmPrice: $360Deposit: $50 (non-refundable); applied to total costAide Fee: $360September 13September 20September 27October 11October 18October 25November 1November 8November 15November 29December 6December 20Register for Art and Cooking #1 Early Drop off Register for Art and Cooking #1 Early Drop off Art and Cooking #1 Early Drop off Price: Art and Cooking #1 Early Drop off Aide Fee Price: Culinary Adventures #1Wednesdays, 5:00pm-6:30pmPrice: $540Deposit: $50 (non-refundable); applied to total costAide Fee: $480September 13September 20September 27October 11October 18October 25November 1November 8November 15November 29December 6December 20Register for Culinary Adventures #1 Register for Culinary Adventures #1 Culinary Adventures #1 Price: Culinary Adventures #1 Aide Fee Price: Dining OutThursdays, 6:30pm-8:00pmPrice: $405Aide Fee: $270September 28October 26November 9January 25February 29March 28May 23June 27July 25Register for Dining Out Register for Dining Out Dining Out Price: Dining Out Aide Fee Price: Torah Circle 21+Sundays, 11:30 am - 2:00 pmPrice: $1350Deposit: $50 (non-refundable); applied to total costAide Fee: $1080October 15October 29November 5November 19December 3December 10December 17January 14January 21January 28February 11February 25March 3March 10March 17April 7April 14May 5Register for Torah Circle 21+ Register for Torah Circle 21+ Torah Circle 21+ Price: Torah Circle 21+ Aide Fee Price: Torah CircleSundays, 9:30 am - 12:00 pmPrice: $1350Deposit: $50 (non-refundable); applied to total costAide Fee: $1080October 15October 29November 5November 19December 3December 10December 17January 14January 21January 28February 11February 25March 3March 10March 17April 7April 14May 5Register for Torah Circle Register for Torah Circle Torah Circle Price: Torah Circle Aide Fee Price: Saturday Night OutSaturdays, 6:30pm-8:00pmPrice: $135Aide Fee: $90November 4January 20Register for Saturday Night Out Register for Saturday Night Out Saturday Night Out Price: Saturday Night Out Aide Fee Price: After Care – Wednesday Session 1Wednesdays, 3:00-6:30pmPrice: $525November 22November 29December 6December 13December 20Register for After Care – Wednesday Session 1 Register for After Care – Wednesday Session 1 After Care – Wednesday Session 1 Price: After Care – Monday Session 1Mondays, 3:00-6:30pmPrice: $420November 27December 4December 11December 18Register for After Care – Monday Session 1 Register for After Care – Monday Session 1 After Care – Monday Session 1 Price: After Care – Tuesday Session 1Tuesdays, 3:00-6:30pmPrice: $420November 28December 5December 12December 19Register for After Care – Tuesday Session 1 Register for After Care – Tuesday Session 1 After Care – Tuesday Session 1 Price: Adult Winter Experience At Allies Camp10:00am-3:00pmPrice: $450Deposit: $50 (non-refundable); applied to total costAide Fee: $300Tuesday, December 26Wednesday, December 27Thursday, December 28Register for Adult Winter Experience At Allies Camp Register for Adult Winter Experience At Allies Camp Adult Winter Experience At Allies Camp Price: Adult Winter Experience At Allies Camp Aide Fee Price: Allie’s Winter Camp10:00am-3:00pmPrice: $240Deposit: $50 (non-refundable); applied to total costAide Fee: $300Tuesday, December 26Wednesday, December 27Thursday, December 28Register for Allie’s Winter Camp Register for Allie’s Winter Camp Allie’s Winter Camp Price: Allie’s Winter Camp Aide Fee Price: Culinary and Art #2Tuesdays, 10:00 am - 1:00 pm Price: $1710Deposit: $50 (non-refundable); applied to total costAide Fee: $1330January 2January 9January 16January 23January 30February 6February 13February 20February 27March 5March 12March 19March 26April 2April 9April 16May 7May 14May 28Register for Culinary and Art #2 Register for Culinary and Art #2 Culinary and Art #2 Price: Culinary and Art #2 Aide Fee Price: After Care – Tuesday Session 2Tuesdays, 3:00-6:30pmPrice: $1995January 2January 9January 16January 23January 30February 6February 13February 20February 27March 5March 12March 19March 26April 2April 9April 16May 7May 14May 28Register for After Care – Tuesday Session 2 Register for After Care – Tuesday Session 2 After Care – Tuesday Session 2 Price: Culinary Adventures #2Wednesdays, 5:00pm-6:30pmPrice: $675Deposit: $50 (non-refundable); applied to total costAide Fee: $600January 3January 10January 17January 24January 31February 7February 14March 6March 13March 20March 27April 17May 8May 15May 22Register for Culinary Adventures #2 Register for Culinary Adventures #2 Culinary Adventures #2 Price: Culinary Adventures #2 Aide Fee Price: After Care – Wednesday Session 2Wednesdays, 3:00-6:30pmPrice: $1680January 3January 10January 17January 24January 31February 7February 14March 6March 13March 20March 27April 3April 17May 8May 15May 22Register for After Care – Wednesday Session 2 Register for After Care – Wednesday Session 2 After Care – Wednesday Session 2 Price: Art and Cooking #2Wednesdays, 4:30pm-6:00pmPrice: $675Deposit: $50 (non-refundable); applied to total costAide Fee: $600January 3January 10January 17January 24January 31February 7February 14March 6March 13March 20March 27April 17May 8May 15May 22Register for Art and Cooking #2 Register for Art and Cooking #2 Art and Cooking #2 Price: Art and Cooking #2 Aide Fee Price: Art and Cooking #2 Early Drop offWednesdays, 3:30pm-4:30pmPrice: $450Deposit: $50 (non-refundable); applied to total costAide Fee: $450January 3January 10January 17January 24January 31February 7February 14March 6March 13March 20March 27April 17May 8May 15May 22Register for Art and Cooking #2 Early Drop off Register for Art and Cooking #2 Early Drop off Art and Cooking #2 Early Drop off Price: Art and Cooking #2 Early Drop off Aide Fee Price: Social Club #2Thursdays, 10:00am-1:00pmPrice: $1890Deposit: $50 (non-refundable); applied to total costAide Fee: $1470January 4January 11January 18January 25February 1February 8February 15February 22February 29March 7March 14March 21March 28April 4April 11April 18May 2May 9May 16May 23May 30Register for Social Club #2 Register for Social Club #2 Social Club #2 Price: Social Club #2 Aide Fee Price: Bowling #2Thursdays, 6:30-8:00pmPrice: $225Deposit: $50 (non-refundable); applied to total costAide Fee: $150January 4February 1March 7April 4May 2Register for Bowling #2 Register for Bowling #2 Bowling #2 Price: Bowling #2 Aide Fee Price: Sports #2Mondays, 4:30pm-6:00pmPrice: $630Deposit: $50 (non-refundable); applied to total costAide Fee: $560January 8January 22January 29February 5February 12February 26March 4March 11March 18March 25April 8April 15May 6May 13Register for Sports #2 Register for Sports #2 Sports #2 Price: Sports #2 Aide Fee Price: Sports #2 Early Drop offMondays, 3:30pm-4:30pmPrice: $420Deposit: $50 (non-refundable); applied to total costAide Fee: $420January 8January 22January 29February 5February 12February 26March 4March 11March 18March 25April 8April 15May 6May 13Register for Sports #2 Early Drop off Register for Sports #2 Early Drop off Sports #2 Early Drop off Price: Sports #2 Early Drop off Aide Fee Price: Sports and Social Time #2Mondays, 5:00pm-6:30pmPrice: $630Deposit: $50 (non-refundable); applied to total costAide Fee: $560January 8January 22January 29February 5February 12February 26March 4March 11March 18March 25April 8April 15May 6May 13Register for Sports and Social Time #2 Register for Sports and Social Time #2 Sports and Social Time #2 Price: Sports and Social Time #2 Aide Fee Price: After Care – Monday Session 2Mondays, 3:00-6:30pmPrice: $1575January 8January 22January 29February 5February 12February 26March 4March 11March 18March 25April 8April 15May 6May 13May 27Register for After Care – Monday Session 2 Register for After Care – Monday Session 2 After Care – Monday Session 2 Price: After School Fun #2 Early Drop offTuesdays, 3:30-4:30pmPrice: $450Deposit: $50 (non-refundable); applied to total costAide Fee: $450January 9January 16January 23January 30February 6February 13February 27March 5March 12March 19March 26April 9April 16May 7May 14Register for After School Fun #2 Early Drop off Register for After School Fun #2 Early Drop off After School Fun #2 Early Drop off Price: After School Fun #2 Early Drop off Aide Fee Price: After School Fun #2Tuesdays, 4:30 - 6:00 pmPrice: $675Deposit: $50 (non-refundable); applied to total costAide Fee: $330January 9January 16January 23January 30February 6February 13February 27March 5March 12March 19March 26April 9April 16May 7May 14Register for After School Fun #2 Register for After School Fun #2 After School Fun #2 Price: After School Fun #2 Aide Fee Price: Movie Night #2Tuesdays, 6:00-8:00pmPrice: $300Aide Fee: $200January 16February 13March 19April 9May 14Register for Movie Night #2 Register for Movie Night #2 Movie Night #2 Price: Movie Night #2 Aide Fee Price: Culinary and Art #3Tuesdays, 10:00 am - 1:00 pm Price: $720Deposit: $50 (non-refundable); applied to total costAide Fee: $560June 4June 11June 18June 25July 2July 9July 16July 23Register for Culinary and Art #3 Register for Culinary and Art #3 Culinary and Art #3 Price: Culinary and Art #3 Aide Fee Price: Social Club #3Thursdays, 10:00am-1:00pmPrice: $540Deposit: $50 (non-refundable); applied to total costAide Fee: $420June 6June 20June 27July 11July 18July 25Register for Social Club #3 Register for Social Club #3 Social Club #3 Price: Social Club #3 Aide Fee Price: Bowling #3Thursdays, 6:30-8:00pmPrice: $90Deposit: $50 (non-refundable); applied to total costAide Fee: $60June 6July 11Register for Bowling #3 Register for Bowling #3 Bowling #3 Price: Bowling #3 Aide Fee Price: Movie Night #3Tuesdays, 6:00-8:00pmPrice: $120Aide Fee: $80June 18July 16Register for Movie Night #3 Register for Movie Night #3 Movie Night #3 Price: Movie Night #3 Aide Fee Price: FC Summer Camp Week #1Monday-Thursday: 9:30am-3:00pmPrice: $320Deposit: $100 (non-refundable); applied to total costAide Fee: $440Week #1: Monday, July 29Tuesday, July 30Wednesday, July 31Thursday, August 1Register 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 #2Mon-Thurs; 9:30am-3:00pmPrice: $320Deposit: $100 (non-refundable); applied to total costAide Fee: $440Week #2: Monday, August 5Tuesday, August 6Wednesday, August 7Thursday, August 8Register 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: $320Deposit: $100 (non-refundable); applied to total costAide Fee: $440Week #3: Monday, August 12Wednesday, August 14Thursday, August 15Friday, August 16Register 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: $320Deposit: $100 (non-refundable); applied to total costAide Fee: $440Monday, August 19Tuesday, August 20Wednesday, August 21Thursday, August 22Register for Allies Summer Camp Register for Allies Summer Camp Allies Summer Camp Price: Allies Summer Camp Aide Fee Price: Allie’s Summer Camp 21+Monday-Thursday: 9:30am-3:00pmPrice: $660Deposit: $100 (non-refundable); applied to total costAide Fee: $440Monday, August 19Tuesday, August 20Wednesday, August 21Thursday, August 22Register for Allie’s Summer Camp 21+ Register for Allie’s Summer Camp 21+ Allie’s Summer Camp 21+ Price: Allie’s 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 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.CommentsThis field is for validation purposes and should be left unchanged. Δ
