Family Registration - The Friendship Circle of Washington

Step One: Register

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. Filling out this form does not guarantee your child a spot in our program, and registration will not be considered complete until payment has been received.

Step Two: Meet with Friendship Circle

Friendship Circle requires that all new families participate in an intake meeting before they can participate in programs. You will meet with our Program Manager who will give you an overview of our programs, how to RSVP, and discuss the programs that you would like to participate in. The intake is also a good time to ask any questions or share any concerns you may have, and discuss payment options, including DDA.

Step Three: RSVP for Programs

Once we receive your registration form and you’ve met with a volunteer coordinator, you will receive a welcome email with information on how to RSVP for programs and will be added to our email and text communications! Then you’re ready to attend your first program! We ask that a parent of guardian stay for the duration of your first program visit.

If you have any questions, please feel free to email Rebecca Mohr at [email protected]

This form is to enroll for the year, please see the Programs page to RSVP for 2026/2027 events!

First Name*

Last Name*

Nickname

Birth Date*

Month Day Year

Gender*

Street Address*

City*

Postal/Zip Code*

Have you been involved with Friendship Circle in the past?*

YesNo

What school do you/does your child attend?*

Parent First Name*

Parent Last Name*

Parent E-mail*

Parent Phone Number*

Parent address (if different from participants)

Place of work*

Job title*

Parent 2: First Name*

Parent 2: Last Name*

Parent 2 E-mail*

Parent 2 Phone Number*

Parent address (if different from participants)

Parent 2 Place of work*

Parent 2 Job title*

Please share with us any helpful hints: what are the most important things your child's Friend should know about them? *

Synagogue Affiliation If you have a synagogue affiliation: Please share it here or please write N/A*

Please upload a photo of your child: This will only be used to help your childs friend know what they look like before meeting them in person!

Primary Care Doctor*

First Name Last Name

Primary Care Doctor phone number*

Emergency Contact*

First Name Last Name

Emergency Contact phone number*

Emergency Contact relationship to participant*

What allergies does your child have? N/A if none*

Do any of the above allergies require immediate Emergency Medical attention?

Any Medical Conditions that we should be aware of? N/A if not relevant

2026/27 Programs: Select the Program/s you are interested in*

Racial Demographics*

We encourage all families to participate with an annual membership for the year. Your participation allows us to continue serving you and your childs needs. If you are unable to do so and would like to use DDA funds please let us know.

Program Year Enrollment:
There are two payment options available for your child’s enrollment in the upcoming program year:

Friend Level – $360
Best Friend Level – $500

Both options cover enrollment for the upcoming program year. Please select the level that works best for your family!

I would like to: *

Be a Friend - $360.00 by Credit CardBe a Best Friend - $500.00 by Credit CardPay $360.00 using DDA fundsUtilize a full scholarship

Amount to Charge Credit Card:

$360$500

Total charged to credit card:

$0.00

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Photo Release*

Yes - I Give Friendship Circle Permission to Share Photos of My Child In Newsletters, Social Media Posts, Etc.No - I Do Not Give Friendship Circle Permission to Share Photos of My Child In Newsletters, Social Media Posts, Etc.

I Agree:*

Release of Liability * 1. I give my child permission to participate in Friendship Circle programming and events. 2. I release the Friendship Circle of Washington, its providers, and administrators, from all liability for any incident which affects the health, welfare, or safety of my child in the provision of such service. 3. I waive all rights to sue the aforementioned organizations for any of the above-mentioned incidents which may occur at The Friendship Circle.

I Agree:*

Commitment Statement * Friendship Circle partners with families to ensure safety, fun, and friendship for children and teens with special needs. As part of our programming, I understand and agree to the following statements: 1. Involvement with The Friendship Circle may expose my child to novel activities and interactions the may be a new experience for my child. 2. I will provide an emergency contact person that can be reliably and responsibly reached for my child during FC programming. 3. I will notify FC promptly when I know that my child is unable to attend an event or program we have RSVP'd for. 4. I agree to disclose all critical and supporting information about my child that will help FC staff and volunteers ensure their fun and safety.

I would like to receive news and updates by email

E-mail

Step Two: Meet with Friendship Circle

Step Three: RSVP for Programs

2026-2027 Friendship Circle Family Registration