Circle of Friends Registration
Circle of Friends - Wednesdays at 4:00 September 8 - December 11 | Please fill out this form and click submit.
Name
*
Email
*
This address will receive a confirmation email
Phone
*
Address
*
--
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Child/Youth's Name - 1
*
Age
*
Please select one option.
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Select Option
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Birthdate
*
Grade
*
Please select one option.
K
1
2
3
4
5
6
7
8
9
10
11
12
Select Option
K
1
2
3
4
5
6
7
8
9
10
11
12
Child/Youth's Name - 2
Age
Please select one option.
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Select Option
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Birthdate
Grade
Please select one option.
K
1
2
3
4
5
6
7
8
9
10
11
12
Select Option
K
1
2
3
4
5
6
7
8
9
10
11
12
Child/Youth's Name - 3
Age
Please select one option.
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Select Option
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Birthdate
Grade
Please select one option.
K
1
2
3
4
5
6
7
8
9
10
11
12
Select Option
K
1
2
3
4
5
6
7
8
9
10
11
12
My child(ren) have these allergies:
*
My child(ren) have these special needs:
*
Transportation: Do you need assistance with transportation?
*
Please select one option.
Yes
No
Select Option
Yes
No
Photography: SPC has my permission to use pictures taken during RoundTable for publicity or on bulletin boards
*
Please select one option.
Yes
No
Select Option
Yes
No
Medical: I give my permission for the staff of RoundTable to administer basic first aid. In case of emergency, RoundTable staff are authorized to seek medical care and transport to a hospital if necessary.
*
Please select one option.
Yes
No
Select Option
Yes
No
COVID: We encourage people to follow their own conscience and be respectful of others. I will not send my child(ren) if he/she has been exposed to the virus, has a temperature, or is not feeling well.
*
Please select one option.
Yes
No
Select Option
Yes
No
Costs: Payment for this program is $40 per child, which covers September 8 through December 11 (8 nights of Circle of Friends, 4 nights of IGnite). Scholarship help is available for those who apply. Applications are available in the church office.
Submit
Description
Circle of Friends - Wednesdays at 4:00 September 8 - December 11
Please fill out this form and click submit.
×
Please Fix the Following