Children & Teen Sign Up Form (18 & Under)

While we are a Jewish organization, we welcome friends from all walks of life. It is helpful for us to understand your connection to the Jewish community.

We recommend listing teachers, coaches, or employers as references.

Safety & Health Information

Please note all sections are required.

Getting to Know You

For Reporting Purposes (Optional):
Our donors and grant funders are deeply invested in understanding the diverse community we serve and the variety of diagnoses represented. Sharing this information helps us communicate the scope of our impact—but it does not affect the individualized, person-centered approach we take with your child in any of our programs.

If you are comfortable sharing, your response will be used for reporting purposes only and will be kept anonymous.

Programming Information

Service Agreement

I (Participant or Parent/Guardian) hereby give permission to the staff of Philly Friendship Circle to obtain necessary emergency medical treatment for myself/my child with the understanding that the family will be notified as soon as possible.

I (Participant or Parent/Guardian) hereby release Philly Friendship Circle, its providers and administrators, from all liability for any incident which affects the health, welfare, or safety of myself/my child in the provision of such service.

I (Participant or Parent/Guardian) permit Philly Friendship Circle to use my contact information for phone, text and email communications. Msg & data rates apply – please contact Philly Friendship Circle staff to be removed from messaging lists.

I (Participant or Parent/Guardian) permit my/my child’s photograph and video to be used for publicity purposes – please contact Philly Friendship Circle staff to be removed from publicity lists.

I (Participant or Parent/Guardian) permit my/my child’s name to be printed on select Friendship Circle materials – please contact Philly Friendship Circle staff to be removed from print lists.