Circle Of Friends 2017-2018 Registration Form

Contact: Marnie Carlson

Phone: 612-767-2213

Email: marniec@mtolivet.org

I need to register *

A New Participant

A Returning Participant

Participant Information

First Name *

Last Name *

Sex *

Male

Female

Email Address *

Birthdate *

School *

Grade 2017-18 *

T-Shirt Size *

1st Parent/Guardian First Name *

1st Parent/Guardian Last Name *

Street Address *

City *

State *

Zip Code *

Home Phone *

Cell *

Email Address *

Please email me updates

2nd Parent/Guardian First Name *

2nd Parent/Guardian Last Name *

Street Address *

City *

State *

Zip Code *

Home Phone *

Cell *

Email Address *

Is it okay to have your information made available to members for carpooling and social purposes? *

Yes

No

Emergency Contact

Emergency contact (non-parent) if parents cannot be reached:

First Name: *

Last Name: *

Relationship to participant: *

Cell: *

Participant Questions

What kinds of things do you like to do? *

What do you hope will happen in this program? *

Participant Questions

What were your favorite C.O.F. events last year? *

What can we do to make the most out of your time with C.O.F.? *

What do you hope will happen in this program this year? *

Parent/Guardian Questions

What is your goal for the program? *

Please describe the participant's diagnosis and disability. *

Are there any changes you would like to see or suggestions you have to make C.O.F. more successful? Or any new activities you would like C.O.F. to do? *

Who were your child's partners last year? How did it go with them? Were there any difficulties? Please be specific, it will help me in placing your child with the right partner for them. *

Is there any information that would be helpful in finding a partner for your child? *

Are there any strong likes/dislikes? *

Allergies or strong precautions? *

Payment

Circle of Friends is $225 for the whole year

Payment Options
Pay in full today $225
Make 1st Payment $125 (Second payment $100 due January 29th) *

Pay $50.00

Pay in full today

Make 1st payment

Circle of Friends is $225 for the whole year

Payment Options

Make 2nd Payment $100, due January 29th *

Make second payment (due January 29th)