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2025/26 Adult Registration Form
(Ages 18+)

2025/26 Adult Registration Form (Ages 18+)

Please complete this form in it’s entirety and be as detailed as possible as this is the information we share with our program staff and therapists. Some of our programs partially rely on grants for funding, and certain pieces of information are collected for the purpose of required grant reporting. Client privacy protection will be observed in accordance with those rules set forth in the Health Insurance Portability and Accountability Act (HIPPA).

Are you a new or returning partcipant?
Participant's Name
Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.
Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.
Primary Parent/Guardian or Caretaker
Primary Parent/Guardian Address
Secondary Parent/Guardian Caretaker
Authorized Person #1 (Pick-up and Drop-off)
Authorized Person #2 (Pick-up and Drop-off)

Medical/Behavioral Information

Medical/Health Related Conditions Please select all that apply
Does the participant carry emergency medicine on them and will be bringing to programs? (Ex: Epi-pen or Seizure Spray)
If you child carries an EPI- PEN you MUST carry Benadryl to administer as well. Friendship Circle Miami WILL ONLY administer NASAL SEIZURE SPRAY AND EPI-PEN, we WILL NOT administer daily medications, NSAIDS or rectal seizure spray. In the event of a seizure or epi-pen is required 911 will be called as well as Primary Contact.
Is the Participant potty trained?
Please specify any behaviors the Participant may exhibit or any new behaviors that may be occuring.
Please let us know what fidget/sensory toy or any preferred items the participant likes so we can try to have those items available here for them.
Does the Participant currently receive behavioral therapy services?
Will the Participant be attending programs with their own Registered Behavior Technician (RBT)?

Scholarships

Scholarship opportunities are available.
If you would like to be considered for scholarship assistance, please indicate your median household income below. Be sure to select all programs you wish to participate in. Once your form is reviewed, an invoice will be sent to you via email with a scholarship code to enroll for programs.

Do you need to apply for scholarship assistance for the 2025–2026 program year?

Friendship Circle Program(s):

Please let us know which programs you’d like to register for, and we’ll promptly send over an invoice to secure your spot. For NEW participants, during our in-person intake meeting we will go over all the programs! For families interested in a more comprehensive experience, we also offer an Annual Membership.
Annual Membership
Includes all Sunday–Thursday programs, Adult Social Group and No School Fun Days | Excludes Winter Break, Spring Break, Summer Camp, and Summer Programs | Coverage: September 2025 – May 2026. No School Fun Day and All Camps are for ONLY AGES 18-30.
Sunday Circle: 2 Sundays a month from 10AM -12PM: Ages 18-25
Join us twice a month on Sundays from 10:00AM – 12:00PM for a fun and engaging session filled with creative activities and social interaction designed to inspire and connect. Ages 18 - 30 only.
Movement Circle: (Mondays from 4:00 -5:00 PM)
Join us every Monday from 4:00PM – 5:00PM for an engaging and energetic movement session.
Art Circle: (Mondays from 5:00 -6:00 PM)
Join us every Monday from 5:00PM – 6:00PM for Art Circle.
Sports Circle (Tuesdays from 5:00 - 6:00PM): Free
Get active and develop teamwork every Tuesday from 5:00PM – 6:00PM in Sports Circle, where all skill levels are welcome, in partnership with The Special Olympics. Space is limited. If your child is absent more than 5 times, we reserve the right to give your spot to another child.
Karate Circle: (Wednesdays from 4:00 - 5:00PM)
Get active and develop teamwork every Wednesday from 5:00PM – 6:00PM in Karate Circle with Kia Kidz, where all skill levels are welcome.
FC Band: (Wednesdays from 5:00 - 6:00 PM)
No experience is needed. If your child is absent more than 5 times, we reserve the right to give your spot to another child.
Cooking Circle: (Thursdays from 5:00-6:00)
Learn and prepare food skills such as mixing, following recipes, chopping, and more every Thursday from 4:00PM – 5:00PM
Adult Social Group (2 Tuesdays: 6:30 -8)/ (1 Sunday: 1:30 - 4:30)
(1) Sunday a month: 1:30 - 4:30 PM/ (2) Tuesdays a month: 6:30 - 8:00 PM. Tuesdays are in house activities. Sunday is a field trip.
I am also interested in the following programs:
Connect with other parents, gain support, and find resources in a welcoming space designed to empower and strengthen families on their special needs journey.

Discover Friendship Circle's Project Lifeline - Your Partner in Supporting Children with Special Needs

Navigating the many services available for children with special needs can feel overwhelming—that’s where Project Lifeline steps in. Our dedicated Social Worker works closely with your family, beginning with a thorough assessment to understand your child’s unique strengths and needs. Together, we’ll develop a personalized plan connecting you to the right programs and resources tailored just for you.

With ongoing, individualized support, Project Lifeline helps you access community services that truly make a difference for your child and family. Best of all, all our services are provided completely free of charge.

Let us help you find the support your family deserves—reach out today to learn more about how Project Lifeline can make a difference in your journey.

To learn more, please visit Project Lifeline

Are you interested in actively contributing to our community by joining the Parent Committee? If so, please specify the programs you would like to be involved with.
Our Parent Committee is committed to supporting and enhancing our programs and community. If you are interested in becoming a member, please indicate the programs in which you would like to participate.

Important Information:

I hereby grant permission for photographs of my child, without any identifying information, to be used by Friendship Circle and its partners for publicity related to Friendship Circle activities.
We sincerely appreciate your support in helping us share the impact of our programs with the community. By allowing us to highlight your child’s talents, you contribute to keeping our costs low and our marketing efforts authentic and effective.

Waiver

LEGAL GUARDIAN READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE REPRESENTING THAT YOU ARE THE LEGAL GUARDIAN FOR THE ADULT PARTICIPANT SPECIFIED HEREIN, AS APPOINTED BY A COURT OF LAW (PURSUANT TO FLORIDA STATUTE, CHAPTER 744). I, represent that I am the legal appointed guardian of the adult participant and am legally competent to execute contracts for and on behalf of adult participant in my sole and singular capacity. I, for myself, my heirs and personal representatives, and on behalf of the adult participant, hereby assume all liabilities, risks, injuries and hazards to the adult participant incidental to, or as a result of, participation in the programs and activities of The Friendship Circle of Miami, Inc., including, but not limited to, engaging in activities with persons with special needs, learning in a classroom environment, participating in outdoor events such as: hiking, swimming, horseback riding, exploring, sports, martial arts, day trips including transportation TO AND FROM the said activity. I freely acknowledge the fact that this/these program(s) may have, and/or do involve, physical contact or other conditions or factual circumstances where physical or other injuries, including but not limited to death, may occur, and that transportation to and from said event could involve the potential for an automobile, or other, accident. As legal guardian for the adult participant and on behalf of the adult participant, I do hereby waive, release and agree to indemnify and hold harmless The Friendship Circle of Miami, Inc., their officers, agents, employees, volunteers, the organizers, sponsors, activity supervisors, co-sponsoring organizations and participants for any claim or cause of action against them for personal injury including death, and property damage resulting from an inherent risk in the activity or program. These inherent risks means those dangers or conditions, known or unknown, which are a characteristic of, intrinsic to, or an integral part of the activity and which are not eliminated even if The Friendship Circle of Miami, Inc., their officers, agents, employees, volunteers, the organizers, sponsors, activity supervisors, co-sponsoring organizations and participants, acts with due care in a reasonably prudent manner; and includes, but is not limited to: failure to warn the guardian or adult participant of an inherent risk; and the risk that the adult participant or another participant in the activity may act in a negligent or intentional manner and contribute to the injury or death of the adult participant. I, as legal guardian of the above referenced adult participant, and on behalf of the adult participant, assume all risk of injury, liability, and loss arising from the adult participant’s participation or presence at said activity. I acknowledge that The Friendship Circle, Inc., will not assume any costs relating to any injury while the adult participant is involved in this activity, or from transportation to or from this activity. This Waiver, Release and Hold Harmless/Indemnification Agreement is in consideration of The Friendship Circle of Miami, Inc. permitting the adult participant’s participation in the activity or program at issue and in further consideration of The Friendship Circle of Miami, Inc. not requiring self-funded liability insurance coverage on my part as a condition precedent to the adult participant’s participation in the activity. I, as legal guardian of the above referenced adult participant, and on behalf of the adult participant, freely and voluntarily assume all risk of loss or injury arising from the adult participant’s participation in the activity whether due to my negligence, the adult participant’s negligence, or the negligence or intentional acts of others. I acknowledge that, absent this Release and indemnification, The Friendship Circle of Miami, Inc., or other sponsors of the activity would not have offered me, or the adult participant, the access to the activity because of unacceptable exposure to civil liability claims and/or lawsuits, or the expense of providing a program that is risk-free. By signing this waiver, I agree to indemnify any and all employees and volunteers of The Friendship Circle of Miami, Inc. for any and all damages which result from any and all acts or omissions, including negligence, in whole or in part, on the part of any employee or volunteer of The Friendship Circle of Miami, Inc. I have read and understood this document and sign it freely and knowingly, intending that it shall be fully operative and effective in all respects and that it waives legal rights to which I, or the adult participant, might otherwise be entitled if the adult participant is hurt or suffers loss during the adult participant’s participation in that activity. YOU MUST CAREFULLY READ THIS DOCUMENT BEFORE SIGNING IT. YOU ARE WAIVING OR RELEASING VALUABLE LEGAL RIGHTS. YOU ARE ADVISED TO SEEK THE ADVICE OF AN ATTORNEY IF YOU DO NOT FULLY UNDERSTAND THIS DOCUMENT.
Clear Signature

I understand:

By typing my name below, I understand that the Friendship Circle of Miami, Inc, including without limitation, any of its directors, teachers, employees, or agents, and including any volunteer, shall not be liable to any party for injury or damage, whether from acts of negligence or otherwise, in any way attributable to or in connection with such activities or field trips. I understand and consent that, if there is imminent risk of physical injury to the child or any other person, the use of restraint or seclusion by a trained professional may be administered. I will not hold The Friendship Circle or any of its agents responsible for any injury that may occur due to restraint or seclusion. In case of medical emergency requiring immediate care, I authorize paramedics to take my child to the nearest hospital. I release The Friendship Circle, its providers and administrators, from all liability for any incident which affects the health, welfare or safety of my child(ren) in the provision of such service. I give permission for my child(ren) to participate in off-site field trips as scheduled. You will be advised of such field trips in advance.
Clear Signature
Full Name
Date / Time

Program Payment

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Parent's Name
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