To Calculate Jewish Birthday
 
 
Parent One
Please complete address info if different than above
Parent Two
Please complete address info if different than above
If participating in Friends at Home, which day and what time works best for you?
 
In case of an emergency please contact:
Medical Information
Parental Consent
 
My child has my permission to attend Friendship Circle events. I agree not to hold Friendship Circle liable for any accident, loss or theft that may occur during the course of an event. I hereby give my permission to the physician selected by the Friendship Circle to hospitalize, and/or secure necessary treatment or anesthesia for my child, as named above, in the event that I cannot be reached in an emergency. I hereby give my permission that paramedics can transport my child to the nearest hospital, if necessary. I have indicated any pertinent medical information above. I agree to the terms and conditions of this application.