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Family Registration

Family Registration

Joining Friendship Circle

For all new families interested in joining Friendship Circle there is a three step process to get started. If you already had an intake you can get started by registering bellow.

Step One: Register for an Intake Meeting

Friendship Circle requires that all new families participate in an intake meeting before their child participates in programs. You will meet with a family coordinator who will give you a tour of our facility and discuss the programs that are available for your child. The intake is also a good time to ask any questions or share any concerns you may have. Intake Meetings are generally held twice a week. Please contact Leah at leah@fcaz.org or 602-861-1600 to schedule your intake meeting.

Step Two: Registration for Programs

Once you have participated in an intake meeting you can now register your child for programs.

Step Three: Pairing of Volunteers

Once your registration has been accepted our volunteer coordinators will work on pairing an appropriate volunteer with your child. Depending on the program selected and the time of year you have registered there may be a delay of 2-3 weeks before your child can participate in programs.

2016-2017
Friendship Circle Registration Form
Child's Info

Child's Name

Birth Date

/ /
Month Day Year

Address

City

State Zip

Phone Number

Temple Affiliation
Father's Info

Name

Address if Different

Cell Phone
E-Mail
Mother's Info
Name
Address if
Different
Cell Phone
E-Mail
Would you like to receive emails from our FC parent network? Yes No
Important Info
What is your child's special need?
Does your child occasionally exhibit any of the following behaviors?
Biting Cursing Grabbing Hitting Kicking Pulling Hair
Other
What is your best method of handling the situation?

What are your child's favorite indoor & outdoor activities?

Other things you would like to tell us about your child


Medical Info

Emergency contact name
(other than parent)

Phone

Cell

Please list any allergies
Please list any medical conditions that we should be aware of
Programs
Friends @ Home

Friends @ Home Signup

When would you like volunteers to come and visit your home?

1st choice
Day of the week

Time

2nd choice
Day of the week

Time

Would you be interested in having the same volunteers or new volunteers
Respite Service Agreement
It is our pleasure to provide you with our Friends At Home service, however it is necessary for a parent/guardian to be home at all times & assume responsibility to oversee activities shared together.
I/We (Parent/Guardian) release the Friendship Circle, its providers and administrators, from all liability for any incident which affects the health, welfare or safety of (child) in the provision of such service.
Please type your signature:
Date:

Sunday Circle
$150 per year
Sundays, 1:30pm-3:30pm

September 11
October 9
November 6

December 4
January 8
February 5

March 5
April 2
May 7


Camp
Winter Camp - December 19-22 [$275 session]
Summer Camp - June 5-9 [$350 session]

Family Holiday Events

Chanukah workshop - Sunday, December 11
Tu B'Shvat Shabbat Dinner - Friday, February 10 [$36 per family]


Birthday Club
Sunday, November 20
Sunday, January 15
Sunday, March 26

Teen Scene [$15 per session]
Date:
Time:
Sunday, September 25 2:00pm-3:00pm
Sunday, November 13 2:00pm-3:00pm
Sunday, January 22 2:00pm-3:00pm
Sunday, February 12 2:00pm-3:00pm
Sunday, March 19 2:00pm-3:00pm

Save the Dates

January 29 - Jonathan's Walk4Friendship

May 14 - Award Ceremony
Payment Info
Total Registration Fees:
Additional Donation:

Please Select One:
Please charge my cc in full.
Please charge half now and half in
Please bill me in full
Please bill me half now and half in
Total amount to be charged today:
Name on card:
Card Type:

Comments (optional)

Card Number:
Expiration:
Billing Zip: CVV:
*Please note no one is turned away due to lack of funds. Please ocntact our office for assistance.
Signature
In the event that my child is unable to attend any of the above selected programs, I will notify the Friendship Circle.


I allow my child's photos to be used for any and all Friendship Circle publicity purposes.
Yes
No

Who is filling out this form?
Father Mother Legal Guardian
Please type your signature: Date:
Please enter your email address:
An email receipt will be sent to this email address

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