Winter Camp 2025 - Parent/Caregiver Registration Form

This form is currently closed.

REGISTRANT INFORMATION & EXPECTATIONS

This form is for currently involved parents/caregivers that are signing up their child. If you/your child have not attended a program in the past three months, please reach out to Tova to confirm your spot: tova@friendshipdallas.org

If you are over the age of 13 and signing up for yourself, please fill out our Teen Registration Form.

~~Registration closes on Friday, December 12th.~~

Registration was extended through Friday, December 19th.
Has your child attended Friendship Circle of Dallas programs before?*

YesNo
How did you hear about us?*

Website or search engineSocial mediaFriend or family referralProfessional referralOther
Please share their name so we can thank them!
We're so glad you're joining us!
We’re so excited to welcome you!

If your child has not participated in Friendship Circle programs before, we’ll need to gather a bit more information before confirming their spot.

Please share your contact information so we may reach out to you.
Full Name*
First Name Last Name
E-mail*
Phone Number*
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
Winter Camp Schedule:

10:00 AM - 2:00 PM

10:00 AM - 2:00 PM

10:00 AM - 12:30 PM

We kindly ask that parents and caregivers ensure timely drop-off and pick-up each day. As camp spots are limited, participating campers are expected to attend all three days.
I have read and understood the above statement.*

Yes
Optional early drop-off will be offered starting at 9:15 AM for a charge of $10/day. You must sign-up prior to camp using a separate form that will be sent to those interested.
Please check this box if you are interested in early drop-off. This does not guarantee your spot as space is limited.

Send me the form
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 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 they do not apply to your child's needs, or 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), physical activities, etc.
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
Optional. Please consider making a donation to keep these programs free for those who need them!

$100$180$250$360$540
Winter Camp costs approximately $250 per camper.

Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

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