Adult Registration

  • Adult's Information

  • Legal Caregiver Information

  • * If Applicable

  • Help Us Get To Know You a Little Better

  • Emergency Medical Information

  • In case of an emergency, when neither parent can be reached, please provide the name of someone who will take responsibility for your child:

  • Medical and Emergency Release

  • I or authorized representative, I hereby give consent to Friendship Circle that I will attend Friendship Circle events. I agree not to hold Friendship Circle liable for any accident, loss, or theft that may occur during the course of an event. I hereby give my authorization to the physician selected by The Friendship Circle to hospitalize, and/or secure necessary treatment or anesthesia for myself, as named above, in the event that I cannot be reached in an emergency. This care may be given under whatever conditions are necessary to preserve the life, limb or well being of the individual named above. I hereby give my permission that paramedics can transport me to the nearest hospital, if necessary. I have indicated any pertinent medical information above.

  • Signature

  • Should be Empty:
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