Sunday Circle - We Are Back!

Parent Name*

First Name Last Name

Child's Name:*

First Name Last Name

Parent's E-mail:*

Sibling & Parent Participation

Due to the recent fires, we are welcoming siblings to join our Sunday Circle this month. They will have their own activities and games to enjoy while their sibling participates in the program. If your child’s siblings will be attending, please list their names and ages so we can plan accordingly.

We are also inviting parents to stay and relax with coffee and refreshments. This is a great opportunity to connect with other parents while your child enjoys the program. Please indicate if you will be staying or just dropping off your child.

Parent Participation*

Yes, I’d love to join and connect with other parents on the dayNo, thank you – I will be dropping off my child

Sibling Participation: Please list the names and ages of any siblings attending.

Have you attended a Sunday Circle session this school year (2024-2025)?*

Yes, I have already filled out all the necessary formsNo, I have not yet filled out the necessary forms

What does your child enjoy doing most? (outdoor/indoor activities)*

Are there any fears you'd like us to know about (animals, loud noises, etc) and suggestions of how we can deal with them?*

Is your child completely toilet trained?*

YesNo

Does your child need bathroom assistance?*

YesNo

Is there anything else we should know about your child?

Does your child have a friend that would be interested in this program?

yesno

Emergency Contact #1:*

First Name Last Name

Relationship to Child:*

Phone Number:*

Emergency Contact #2:*

First Name Last Name

Relationship to Child:*

Phone Number:*

Health Insurance Provider:*

Policy Number:

Name of Doctor:*

Doctor's Phone Number:*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Doctor's Hospital Affiliation*

Does your child have any allergies? (If yes, please specify.))*

Does your child take medication? (If yes, please specify.)*

Additional Medical Information:

In the event that neither parent nor the emergency contact can be reached, Friendship Circle has my permission to render any necessary first aid or to secure care by a physician to my child while attending Sunday Circle:*

I Agree

Do you consent to photos of your child being used for publicity purposes?*

Yes, but only for Friendship Circle social media and literatureYes, for all publicity purposesNo, I do not consent

I have carefully considered the risks involved and agree to allow my child(ren) to participate in the activities with The Friendship Circle. I also understand that participation in these activities is entirely voluntary and requires participants to abide by applicable rules and standards of conduct as set forth by Friendship Circle. I understand that Friendship Circle is independently owned and operated. In consideration of the opportunity to send my child to The Friendship Circle, and by engaging in participation, I, myself, and on behalf of my child, hereby agree to release, hold harmless, and waive any and all claims against The Friendship Circle and its employees, directors, officers, and volunteers, as well as its affiliates and all other organizations associated with The Friendship Circle, from any and all claims or liability arising out of this participation. I understand that this form involves the release of legal rights.

By entering my initials below, I agree to each statement above and release The Friendship Circle of the West Coast from any and all liability.

Parent Signature*

Date*

Month Day Year

at Hour Minutes

In light of the recent fire tragedy, we are here to support our community during this difficult time. This event is completely on us, and we’re so glad to offer it at no cost to you!

For those who are in a place to contribute, donations are welcome to help cover the costs of the program. If you’d like to give, you can do so using the form below.

I'd like to help cover the cost of this event!

Payment

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

Total

$0.00

Sunday Circle - We Are Back!

Child's Information:

Additional Contacts (In Case of Emergency):

Medical Information:

Parental Consent: