Welcome to Friendship Circle! Your child is about to enter a circle of warm, loving friends who are so excited to include him/her in all of our events and programs. Your child will feel right at home, in a safe and welcoming environment that is open to everyone, in a place full of laughter and love.We can’t wait to have him/her join our circle of friends!Child Registration FormFull Name*First NameLast NameBirth Date*1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearGenderFemaleMaleAddress*Street AddressStreet Address Line 2CityState / ProvincePostal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNagorno-KarabakhNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandTurkish Republic of Northern CyprusNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTransnistria PridnestrovieTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOtherCountryLives with:Both parentsMomDadParents InformationMother’s Name*First NameLast NameMother's Cell Number*Area CodePhone NumberMother's Email:*Mother's Occupation*Best way to be contacted*CallText MessageWhatsappEmailFather’s Name*First NameLast NameFather’s Cell Number*Area CodePhone NumberFather's Email:*Father's Occupation*Best way to be contactedCallText MessageWhatsappEmailParents’ Marital Status:*MarriedDivorcedOtherPlease list one reference, who is not a relative.*NameRelationshipPhone NumberBackground Information Help us get to know your child!What is your child’s primary mode of communication? (e.g. speaks words, speaks full sentences, hand gestures, picture board, etc.)*Is your child sensitive to sounds, touch, water, animals or anything else? If so, how can we help them through it?Are there any specific behaviors your child has that we should be aware of? Please specify.What are some things your child likes to do in his/her free time?*If your child is agitated, what are effective methods you have used to calm him/her down?If applicable, please list any allergies or medical concerns that we should be aware of, and their severity:Respite Service Agreement-RequiredIt is the Friendship Circle’s pleasure to provide its services. However, it is necessary for the parents/guardians to assume responsibility to oversee activities shared together. By signing below, I agree to ensure that a parent/guardian will be home while volunteers are interacting with my child.I also agree to release the Friendship Circle, its providers and administrators from all liability from and incident which affects the health, welfare or safety of my child in the provision of such service.I permit my child’s photo to be used for publicity purposes:*YesNoSign by entering your email*CommentsSubmitShould be Empty: This page uses TLS encryption to keep your data secure.
A look at numbers
225 families who have children with special needs benefit from our programs.
310 teenagers provide more than
20,000 friendship hours annually.