This form can be used to make a payments/register to the Friendship Circle for: Trips, Events, Etc.

First Name

Last name

Address
City
State

Zip Code


Phone


E-mail

Please check off the events/programs you would like to register or make a payment for:

Sunday Circle - Full Session

$150 per child

     

Teen Scene $15 per teen
     
Winter Camp $200 for session
     
Chanukah Disco  *FREE
    Sponsorship and Donations Accepted 
Other  

 

Name(s) of Participants (number of headphones to reserve for disco)

Comments: (song requests for disco)

Payment Info:

Amount to charge
Invoice # (if applicable)


Credit Card #
Expiration
CVV