Sign Up Form

  • Child's Information

  • Parent/Guardian Information

  • Reference Information

    We will contact references as background check for your child( We recommend teachers, therapists, doctors)
  • Safety and Health Information

  • Behavioral Information

  • Personal Information

  • Programming Information

  • Respite Service Agreement

  • I(Parent/Guardian) hereby give permission to the staff of The Friendship Circle to obtain necessary emergency medical treatment for my child with the understanding that the family will be notified as soon as possible.

    I(Parent/Guardian) hereby release The Friendship Circle, its providers and administrators, from all Liability for any incident which affects the health, welfare, or safety of (Child)   in the provision of such service. 

    I(Parent/Guardian) permit Friendship Circle to use my contact information for phone, text and email communications.  Msg & data rates apply - please contact Friendship Circle staff to be removed from messaging lists

    I(Parent/Guardian) permit my child's photograph and video to be used for publicity purposes - please contact Friendship Circle staff to be removed from publicity lists.

    I(Parent/Guardian) permit my child's name to be printed on select Friendship Circle materials - please contact Friendship Circle staff to be removed from print lists.

  • Should be Empty:
Philly Friendship Circle
The Friendship Circle Philadelphia Region South - A registered 501c3 organization serving Philadelphia, Montgomery, Chester and Delaware Counties. 754 South 9th Street Philadelphia, PA 19147 Founded by Chabad- Lubavich