FAMILIES | Friendshipbaltimore

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At Friendship Circle, we know that every family’s path is unique, with its own joys and challenges. Here you will find a caring and supportive community where everyone is appreciated for who they are and has a place to belong.

New Participant Registration

Participant Info

First name

Last name

Gender

Male

Female

Birthday

Month

Day

Year

Address

Home Phone

Does the participant attend a school or day program?

No

Yes

Is the participant affiliated with any congregation?

No

Yes

Parents/Legal Guardian Information

Responsible Party

Dad

Mom

Legal Guardian

Other

First and Last Name

Email

Phone

Occupation

First and Last Name

Email

Phone

Occupation

Medical & Emergency Information

In case of emergency, please provide the name of an additional adult who will assume responsibility for the participant.

Full Name

Relationship to participant:

Phone

If emergency contacts cannot be reached and medical intervention is required, permission is granted to the Friendship Circle staff to contact the participant's physician.

Physician's Name

Phone

In case of a medical emergency where immediate medical care is necessary, I authorize the paramedics to take the participant to the nearest hospital.

Health Insurer

Policy Number

Additional medical information or comments

Allergies

Medications

Dietary Restrictions

Comments

Signature

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Parental/Legal Guardian Agreement

I agree that a parent/legal guardian will be present during all Friends@Home visits.

I am aware that all participants’ photos may be used for publicity purposes.

I hereby release the Friendship Circle, its providers and administrators from ALL liability resulting from any incident which affects the health, welfare or safety of the participant during any Friendship Circle program.

Programs

From the following programs, which would you like to sign up for? Please select only those that apply to the age of the participant.

Youth Programming (Ages 1-12)

Friends@Home

Monthly Sunday Social

Holiday Events

Teen Programming (Ages 13-17)

Friends@Home

Monthly Sunday Social

Holiday Events

Young Adult Programming (Ages 18+)

Monthly Sunday Social

Spark Throughout the Year

Spark Summer Program

Holiday Events

New Participant Registration

Parents/Legal Guardian Information

Programs

ADDRESS

PHONE

EMAIL