Children's Circle Sign Up Form

Children's Circle Registration Information:

Full Name*

First Name Last Name

Parent Email*

Additional Information:

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?*

Yes No

Does your child need bathroom assistance?*

Yes No

Is there anything else we should know about your child?

Total Amount scholarships available upon request

150

Payment

Credit Card Other

Postal / Zip Code

Country

Parental Consent:

I permit my child's photos to be used for publicity purposes:*

Yes No

I permit my child to be taken off Friendship Circle premises for special trips.*

Yes No

In the event that my child is unable to attend one of the below sessions, I will notify The Friendship Circle as soon as possible so they can plan accordingly.*

Yes

Waiver:

The Friendship Circle is strictly adhering to the CDC guidelines and taking all precautions to ensure a safe environment for all participants.

I have carefully considered the risk 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 release of legal rights.

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

Today's Date

Month Day Year

Parent Signature*