Camp Friendship - Parent/Caregiver Registration Form

Is this your fist time at Friendship Circle?*

YesNo
How did you hear about us?*

Friend or family memberRise School of DallasSocial mediaOther
Please share their name so we can thank them!*
REGISTRANT INFORMATION & EXPECTATIONS

This form is for parents/caregivers that are signing up their child. If you are over the age of 13 and signing up for yourself, please fill out our Teen Registration Form.
Important Note: Friendship Circle of Dallas is not a behavioral health, therapeutic, or clinical service provider. We are a community-based organization focused on fostering friendship, inclusion, and connection through social programming.

To ensure the safety and success of all participants, it is essential that families provide accurate and thorough information regarding their child’s needs, including behavior, communication, feeding, toileting, and any required supports.

Incomplete or inaccurate information may affect our ability to provide appropriate accommodations and could result in a delay or inability to participate in programming.
I have read and understood the above statement.

Yes
Camp Friendship is scheduled for Monday, August 3rd through Friday, August 7th.

Registration closes on Friday, July 17th.
I have read and understood the above statement.*

Yes
Campers must bring a labeled water bottle and a nut-free lunch each day. Snacks or meals containing any type of nuts are not permitted for the safety of all participants.

Please label all personal items clearly or send disposable items when possible. While we make every effort to keep track of belongings, we cannot guarantee that items will return home especially if they are not labeled with names.
I have read and understood the above statement.*

Yes
CAMPER INFORMATION
Camper Full Name*
First Name Last Name
Camper Date of Birth*

Month Day Year
Camper Gender*

MaleFemale
Please describe any allergies or type "N/A."
Please describe any dietary restrictions or type "N/A."
PARENT/CAREGIVER INFORMATION
Parent/Caregiver Full Name *
First Name Last Name
Parent/Caregiver 1 Phone Number*
Parent/Caregiver 1 Email*
Parent/Caregiver 2 Full Name*
First Name Last Name
Parent/Caregiver 2 Phone Number*
Parent/Caregiver 2 Email*
Is anyone else authorized to drop off or pick up the camper? Please write their name and describe their relation to the camper.
NEEDS ASSESSMENT

The following section relates to medical, behavioral, or support needs that may or may not apply to your child. These questions help us create a safe and inclusive environment for all participants.

You are welcome to skip this section or leave questions blank if your child is currently engaged with Friendship Circle on a regular basis.
Would you like to share any medical, behavioral, or support needs to help us create a safe and inclusive experience?*

YesNo, thank you
Please describe any relevant medical information and accomodations needed or type "N/A."
Please describe any relevant behavior information that would help us support the camper, or type "N/A.". This may include common triggers, calming strategies, support needs, or patterns we should be aware of to help them have a positive experience.
Please describe any mobility aids the camper uses (e.g., wheelchair, walker, orthotics) and any support or accommodations they may need for transportation (like riding the bus), swimming, or active games.
How does the camper best communicate?

Conversational speechShort phrases or single wordsGestures and signsPicture-based communication (e.g., PECS, choice boards)AAC device (tablet, talker, etc.)Other
If you selected "other", please describe:
LIABILTIY WAIVER
By submitting this form, I acknowledge that participation in Camp Friendship programming involves voluntary activities which may carry risk. I release and hold harmless Friendship Circle of Dallas and its staff, volunteers, and affiliates from any liability related to injury or property damage incurred during participation, except in cases of gross negligence.
I agree to the terms above.*

Yes
ADDITIONAL INFORMATION
Anything else you want us to know?
Thanks for your interest in Camp Friendship! We’ll be in touch soon to learn more about your child and confirm their spot.

For non-members, the registration fee is $180 and will be due upon confirmation. Scholarships may be available.
Please consider making a donation to keep these programs free for those who need them!

$100$180$360$540

Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
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Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

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The Friendship Circle of Dallas

The Friendship Circle of Dallas is proudly supported by the Jewish Federation of Greater Dallas.

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