2025/26 Scholarship/Program Addition Children and Teens

Become part of the solution and join our circle!

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).

Child's Name

First

Last

Child's Birth Date

Age (This form is for ages 5-17 ONLY)

Primary Email Address

Primary Phone Number

Authorized Person #1 (Pick-up and Drop-off)

First

Last

Authorized Person #1 Phone Number

Authorized Person #2 (Pick-up and Drop-off)

First

Last

Authorized Person #2 Phone Number

Does your child have any allergies or food allergies? If so, please provide details.

Does your child 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.

Will your child be attending programs with their own Registered Behavior Technician (RBT)?

Scholarships

Did you apply for Scholarship assistance (2025/26)

Friendship Circle Program(s):

Please let us know which programs you’d like to register for…

Sunday Circle

January – May (9 classes) – $180.00

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.

Art Circle: (Mondays 4:00-5:00PM)

Session 1: September 15- December 15 – $105.00
Session 2: January 5 – May 11 – $240.00

Unleash your creativity on Mondays from 4:00PM – 5:00PM in our interactive Art Circle.

Movement Circle: (Mondays 5:00-6:00PM)

Session 1: September 15- December 15 – $105.00
Session 2: January 5 – May 11 – $240.00

Join us every Monday from 5:00PM – 6:00PM for an engaging and energetic movement session.

Sports Circle (Tuesday from 4:00-5:00PM): Free

Session 1: September 16- December 16
Session 2: January 6 – May 12

Get active and develop teamwork every Tuesday from 4:00PM – 5:00PM in Sports Circle, where all skill levels are welcome. If your child is absent more than 5 times, we reserve the right to give your spot to another child.

Swimming Circle (Tuesday from 4:00-5:00PM) Fall/Spring

Fall: Session 1: October 21 – December 16 – $105.00
Spring: Session 2: March 31 – May 12 – $105.00

Must have some swimming experience and comfortable in water. Space is limited. Swimming Circle will be held at Tropical Estates Pool.

FC Band Circle: (Wednesday from 4:00PM – 5:00PM: Free

Full Year: September 17 – May 13

If your child is absent more than 5 times, we reserve the right to give your spot to another child.

Karate Circle: (Wednesday from 5:00 -6:00 pm)

Session 1: September 17 – December 17 – $135.00
Session 2: January 7 – May 12, 2026 – $240.00

Get active and develop teamwork every Wednesday from 5:00PM – 6:00PM in Karate Circle with Kia Kidz, where all skill levels are welcome.

Cooking Circle: (Thursdays from 4:00 -5:00 pm)

Session 1: September 18 – December 18 – $180.00
Session 2: January 8 – May 12, 2026 – $320.00

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.

Program Payment

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Parent's Name

First

Last

Enter Payment Information

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Total

Item Quantity Qty Total

There are no products selected.

Sunday Circle – January – May (9 classes) 1 $180.00

Art Circle: (Mondays 4:00-5:00PM) – Session 1: September 15- December 15 1 $105.00

Art Circle: (Mondays 4:00-5:00PM) – Session 2: January 5 – May 11 1 $240.00

Movement Circle: (Mondays 5:00-6:00PM) – Session 1: September 15- December 15 1 $105.00

Movement Circle: (Mondays 5:00-6:00PM) – Session 2: January 5 – May 11 1 $240.00

Sports Circle (Tuesday from 4:00-5:00PM): Free – Session 1: September 16- December 16 1 $0.00

Sports Circle (Tuesday from 4:00-5:00PM): Free – Session 2: January 6 – May 12 1 $0.00

Swimming Circle (Tuesday from 4:00-5:00PM) Fall/Spring – Fall: Session 1: October 21 – December 16 1 $105.00

Swimming Circle (Tuesday from 4:00-5:00PM) Fall/Spring – Spring: Session 2: March 31 – May 12 1 $105.00

FC Band Circle: (Wednesday from 4:00PM – 5:00PM: Free – Full Year: September 17 – May 13 1 $0.00

Karate Circle: (Wednesday from 5:00 -6:00 pm) – Session 1: September 17 – December 17 1 $135.00

Karate Circle: (Wednesday from 5:00 -6:00 pm) – Session 2: January 7 – May 12, 2026 1 $240.00

Life Skills: (Thursdays from 4:00 – 6:00 pm): Ages 12 -17 – Session 1: September 18 – December 18 1 $180.00

Life Skills: (Thursdays from 4:00 – 6:00 pm): Ages 12 -17 – Session 2: January 8 – May 12, 2026 1 $320.00

Cooking Circle: (Thursdays from 4:00 -5:00 pm) – Session 1: September 18 – December 18 1 $180.00

Cooking Circle: (Thursdays from 4:00 -5:00 pm) – Session 2: January 8 – May 12, 2026 1 $320.00

Subtotal

Total $0.00

Scholarships

Friendship Circle Program(s):

Program Payment

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