Children: Friendship Club: Registration

2023 Friendship Club Registration

Please complete the below form to register for the Friendship Club Program. A separate form must be submitted if you are registering more than one child. We will be in touch confirming registration, program start dates, locations and times.

Step 1 of 4

Child's Name*
First Last
Date of Birth*
Month
Day
Year

Month/Date/Year
Age*
School attending in September 2023
Grade (as of Sept. 2023)*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent's Name*
First Last
Home Phone*
Cell Phone*
Work Phone
Email*
Parent's Name*
First Last
Home Phone*
Cell Phone*
Work Phone*
Email*
Emergency Contact*
First Last
Please list someone other than parents listed above who would be available during program time.
Relation to Child*
Emergency Contact Number*