2024/2025 Program Registration

2024/2025 Program Registration Form
Full Name*
First Name Last Name
Phone Number*

Address*

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

E-mail*
I would like to receive news and updates by email
Are You Apart Of A Regional Center?*

YesNo
Funding is put in place by Regional Center FMS contact to set it up:

[email protected]
Do You Require A Scholarship?

YesNo
If you are in need of a Scholarship, please either contact:

Muka, Program Director at:

[email protected] or 858-633-7238

Shaindle, Volunteer & Program Coordinator at:

[email protected] or 858-215-1281
Have You Been Approved A Scholarship?

YesNo
Scholarship Payment Amount *This amount must have been approved in advance by a Director, if you have not contacted them, please do so.

$
I grant The Friendship Circle of San Diego permission to share the photographs taken during these programs and understand they may used for marketing/publicity purposes (i.e., brochures, newspapers, website, social channels, etc.)*

YesNo
Would You Like To Register For A Fun Pass?* *Access To All Events Each Month For One Flat Rate

YesNo
Programs I'm Registering For *This Form Is Per Child/Per Adult Registration

Friendship Dojo: Adaptive KarateFriends @ Home: A Home "Hangout" With A VolunteerMen's Club: Weekday Programming for Men Aged 17+Shooting Stars: Dance, Art & Music ClassSports Stars: Adaptive Sports ClassSunday Circle: Hebrew School For All!Women's Club: Weekday Programming for Women Aged 17+
Program Registration *This Form Is Per Child/Per Adult Registration

Friendship Dojo: Adaptive KarateFriends @ Home: A Home "Hangout" With A VolunteerMen's Club: Weekday Programming for Men Aged 17+Shooting Stars: Dance, Art & Music ClassSports Stars: Adaptive Sports ClassSunday Circle: Hebrew School For All!Women's Club: Weekday Programming for Women Aged 17+

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

Yes, I'd like to make this a monthly recurring payment.
Total

$0.00
Should be Empty:

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2024/2025 Program Registration Form