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Winter Camp Registration for 2021

Winter break should not be boring! Friendship Circle winter camp is dedicated to making sure that children and teens with diverse abilities get to really enjoy their winter break. Each day features another trip; from Main Event, to Kidzania, and more! The dates this year are December 20-23 from 9:30am-2:30pm. Thursday (December 23) is a short day, from 10:30am- 1pm. Drop off and pick up is from the JCC, and we will be downstairs. We will have snacks but please bring your own lunch!
Schedule:
Please email for a detailed schedule.
*(Although not likely, schedule may change.)
Please note that our max is 45 kids total and we will close registration when we have hit that number so sign up ASAP!
1. Child/ren’s Information
Child 1*
First NameLast Name
Birth Date*
MonthDayYear
Gender*
MaleFemale
Sessions*
Day 1 (December 20) $65Day 2 (December 21) $65Day 3 (December 22) $65Day 4 (December 23) $40All 4 days $225Donation $300
Sessions ($225 for the full session)
Day 1 (December 20)Day 2 (December 21)Day 3 (December 22)Day 4 (December 23)
Pay per day
Day 1 (December 20) $65Day 2 (December 21) $65Day 3 (December 22) $65Day 4 (December 23) $40
Please list any food allergies your child has.
Does this child require a wheelchair? If so, please list name of whomever will accompany your child to camp.
Does this child have any behaviors that we should know about? Please list.
Child 2
First NameLast Name
Birth Date
MonthDayYear
Gender
MaleFemale
Sessions
Day 1 (December 20) $65Day 2 (December 21) $65Day 3 (December 22) $65Day 4 (December 23) $40All 4 Days $225Donation $300
Pay per day
Day 1 (December 20) $65Day 2 (December 21) $65Day 3 (December 22) $65Day 4 (December 23) $40
Please list any food allergies your child has.
Does this child have any behaviors that we should know about? Please list.
If you have additional children please contact us.
2. Parents information
Phone Number*
Area CodePhone Number

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Mother's Name
First NameLast Name
Work Phone
Area CodePhone Number
Cell Phone
Area CodePhone Number
E-mailPrimary email
Farther's Name
First NameLast Name
Work Phone
Area CodePhone Number
Cell Phone
Area CodePhone Number
E-mailPrimary email
How did you hear of us?
3. Emergency Information
Emergency Contact*
First NameLast Name
Phone Number*
Area CodePhone Number
Relationship*
4. Payment Information
Please contact us if you are unable to pay at this time. Our scholarship price is $150, please contact us if that is the amount you can pay. The $300 price includes a donation and goes towards helping cover costs of our camp that are not covered from the basic fee. As many of you know, we try to keep all of our events free but unfortunately the expenses of running our camp make it impossible to do so. Thank you for understanding.
Agreement*
I am signing up my child for camp. I give my child permission to attend all trips and receive medical care in the case of emergency, G-d forbid. I give Friendship Circle permission to photograph and videotape my children and use the photos and videos (without their names) for whatever the camp sees fit.
Questions/Comments
I would like to receive news and updates by email
Total
$0.00

Payment

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

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The Friendship Circle of Dallas

Dallas, TX 75230
214-810-2770

About Us

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About Us

1. Child/ren’s Information

2. Parents information

3. Emergency Information

4. Payment Information