Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

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Birth Date *

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DD

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Reference Name *

First Name

Last Name

Refrence Number *

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Time Slot *

Sign up for Chanukah Doughnut Making Check all that apply

Sunday, December 18 - 10 am - 12 pm

Monday. December 19 - 10:30 am - 12:30 pm

Tuesday, December 20 - 10:30 am -12:30 pm

Wednesday, December 21 - 10:30 am - 12:30 pm

Friday, December 23- 10:30 am - 12 pm

Sunday, December 25 - 10am - 12pm

I allow my photograph to be taken and used for promotional purposes *

Yes

No

Waiver for Friendship Bakery *

I understand that the program is a life skills employability training program and not employment. I will be helping the participant stay on task and whatever else is needed from me for the participant to excel.

In the event that you are unable to come, you will need to notify the Friendship Circle at least 1 day in advance and will try to find a substitute.

Waiver & Release for COVID-19 *

I understand that participation in Friendship Circle activities involves a certain degree of risk and can be physically, mentally, and emotionally demanding. I have carefully considered the risk involved and agree to allow my child(ren) to participate in these activities. I also understand that participation in these activities is entirely voluntary and requires participants to abide by applicable rules and standards of conduct as set forth by Friendship Circle. I also understand that AS AN EXPRESS PRECONDITION OF MY CHILD(REN)’S PARTICIPATION IN FRIENDSHIP CIRCLE THAT I ACKNOWLEDGE AND AGREE THAT ALTHOUGH FRIENDSHIP CIRCLE CARES DEEPLY ABOUT THE HEALTH AND WELL BEING OF ALL FRIENDSHIP CIRCLE, STAFF AND THEIR FAMILIES, FRIENDSHIP CIRCLE CANNOT GUARANTEE THAT COVID-19 OR ANY OTHER VIRUS OR DISEASE WILL NOT BE CONTRACTED BY FRIENDSHIP CIRCLE PARTICIPANTS, THEIR FAMILIES OR STAFF. I UNDERSTAND THAT FRIENDSHIP CIRCLE IS INDEPENDENTLY OWNED, AND OPERATED. IN CONSIDERATION OF THE OPPORTUNITY TO PARTICIPATE IN FRIENDSHIP CIRCLE ACTIVITIES, I, MYSELF AND ON BEHALF OF MY CHILD, HEREBY AGREE TO RELEASE, HOLD HARMLESS AND WAIVE ANY AND ALL CLAIMS AGAINST FRIENDSHIP CIRCLE AND ITS EMPLOYEES, DIRECTORS, OFFICERS, AND VOLUNTEERS AS WELL AS ITS AFFILIATES AND ALL OTHER ORGANIZATIONS ASSOCIATED WITH FRIENDSHIP CIRCLE FROM ANY AND ALL CLAIMS OR LIABILITY ARISING OUT OF THIS PARTICIPATION. IN WITNESS WHEREOF, Participant and Parent or Legal Guardian has executed Release and Waiver as of the date first set forth below.

Electronic Signature

By signing your name you have agreed to the above information.

First Name

Last Name

Date *

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DD

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