Online registration

    Siblings? (required)

    Parent 1 cell (required)

    Parent 1 contact preference
    CellEmail

    Parent 2 cell

    Parent 2 contact preference
    CellEmail

    Emergency contact phone (required)

    Does your child have any food or medical allergies?

    How did you hear about The Friends Grow Friends Foundation, Inc.:

    Payment

    The fee for this program is $180 for 6 sessions. Payment must be received in full prior to the start of each 6-week session.
    I am paying by check*. Please make checks payable to The Friends Grow Friends Foundation, Inc. for $180
    I am paying by cash
    I am paying by credit card or PayPal via the Friends Grow Friends website
    I am paying by Venmo (@TheSocialSmartsFoundation-Inc)

    *There will be a $34 fee for returned checks

    Registration will not be guaranteed until we have received payment in full. The class is first come, first serve, and registration closes on September 19th, 2019.

    RELEASE/PICKUP AUTHORIZATION
    Please provide the name, number, and address of each person who you are authorizing to drop off or pick up your child at The Friends Grow Friends Foundation, Inc. social skills group.

    We must be notified by phone or email before pickup that one of these authorized individuals, other than the child's parent, will be picking up your child.  The individual picking up your child will be asked to show a valid form of ID (i.e. driver's license) before we release your child to them.

    I understand that participants in this social skills program will not be permitted to leave with anyone other than the person(s) I have listed below.

    Pickup 1 cell

    Pickup 2 cell

    Pickup 3 cell

    Signature required (use mouse or finger to sign)

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