Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email Address * Birth Date * MM DD YYYY School * Bar/Bat Mitzvah Date * Congregation * Session * November 2019 February 2020 Parents Information Mother's Name * First Name Last Name Mother's Cell * (###) ### #### Mother's Email * Father's Name * First Name Last Name Father's Cell * (###) ### #### Father's Email * Marital Status Married Divorced Parental Permission * I hereby give my son/daughter permission to participate in Friendship Circle programs. I permit my son/daughter's photo to be used for publicity purposes. I hereby release the Friendship Circle, its providers and administrators, from ALL liability for any incident which affects the health, welfare, or safety of my child in the provision of a Friendship Circle program for the year 2024-2025 Parent Signature * Thank you for submitting your MVP Registration. A staff member will be in touch with you.
