Participant Registration Form

  • Friendship Circle Participant Registration Form 2021-2022

    If you are interested in registering your child or teen with special needs in Friendship Circle's programming and events, please complete the form below. Once this form is received, a staff member will reach out to you to talk about the next steps in the registration process. Filling out this form does not guarantee your child a spot in our program.

    For the safety and well-being of all of our participants, volunteers, and staff, your child may only begin participating in our programming and events once this form is complete and you have spoken to an FC staff member.

    If you have any questions, please feel free to email Kimberleigh Bechtolt, Program Manager: [email protected]

  • Pick a Date
  • We are careful about your child's safety and the safety of our staff and volunteers. Please provide a personal reference. Examples of suitable references include a teacher, therapist, or family friend.

  • Parent Information

  • Information about your Child

    Please fill out the following information about your child. Please be as detailed and specific as possible so that we can best understand where your child is coming from and learn how we can support their growth and success in our programs.

  • Medical Information

  • Membership Fees

    Membership fees help to offset the cost of programs and allows us to offer programs to everyone who needs it. Once your child is accepted into the program, a staff member will follow up with instructions on completing payment.
  • Community and Service Agreements

  • Should be Empty:
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