Summer Adult Program Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.​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). Participant's Name *FirstLastParticipant's Birth Date *Participant's Age *Are you currently registered for the 2025-2026 year with Friendship Circle? *YesNoSummer Programs are for currently for our enrolled participants Ages 18+! If you are not a current participant, click the link below and submit the 2025-2026 registration form. All first time (NEW) participants, MUST complete an in-person intake meeting PRIOR to joining programs. Click here for the: Adult 18+ registration form. Primary Parent/Guardian or Caretaker *FirstLastPrimary Parent/Guardian Email Address *Primary Parent/Guardian Phone Number *Authorized Person #1 (Pick-up and Drop-off) *FirstLastAuthorized Person #1 Phone Number *Authorized Person #2 (Pick-up and Drop-off) *FirstLastAuthorized Person #2 Phone Number *Does the participant have any allergies or food sensitivities? If so, please provide details. *Does the participant carry emergency medicine on them and will be bringing to programs? (Ex: Epi-pen or Seizure Spray) *YesNoIf 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 the Participant be attending programs with their own Registered Behavior Technician (RBT)? *YesNoIf yes, is the Registered Behavior Technician (RBT) capable to manage the behaviors without assistance? *YesNoScholarshipsDid you apply for Scholarship assistance (2025/26)? *YesNoClick yes, if you have gotten a code from Program Manager to prorate the program. Scholarship Code * Apply For more information please email [email protected]Friendship Circle Program(s):Please let us know which programs you’d like to register for...Movement Circle: (4 Mondays from 4:00 -5:00 PM)July 6 - July 27 - $60.00Join us every Monday from 4:00PM – 5:00PM for an engaging and energetic movement session.Art Circle: ( 4 Mondays from 5:00-6:00 PM)July 6 - July 27 - $60.00Join us every Monday from 5:00PM – 6:00PM for Art Circle. Karate Circle: ( 4 Wednesdays from 4:00 - 5:00PM)July 8- July 29 - $60.00Get active and develop teamwork every Wednesday from 4:00PM – 5:00PM in Karate Circle with Kia Kidz, where all skill levels are welcome.FC Band (4 Wednesdays from 5:00-6:00) FREEFC BANDNo experience is needed. Cooking Circle: (4 Thursdays from 5:00 - 6:00 PM)July 9 - July 30 - $80.00Learn and prepare food skills such as mixing, following recipes, chopping, and more every Thursday from 5:00PM – 6:00PM | Disclaimer: Participation in our cooking class is not encouraged for individuals with food allergies, including but not limited to wheat and nuts. Ingredients containing common allergens are used throughout the facility, and cross-contamination cannot be guaranteed to be avoided.Adult Social Group: (2 Tuesdays: 6:30 - 8:00PM)/ (1 Sunday: 1:30 - 4:30)BOTH Tuesdays and Sundays - $70.00Tuesday ONLY: July 7 & July 28 - $50.00Sunday ONLY: July 19 - $30.00Tuesday: (6:30-8PM): July 14 & 21 | Sunday: (1:30-4:30PM): July 19Adult Culinary Program: ( 4 Tuesday and 4 Thursday: 1:00-3:00PM)Adult Culinary Program - $180.00Tuesdays: July 7, 14, 21, 28 | Thursdays: July 9, 16, 23, 30 | The Friendship Adult Culinary Program, a partnership between Mitzvah Kitchen and Friendship Circle of Miami, offers hands-on cooking experiences that build practical culinary skills, confidence, and independence. To support a positive group environment, participants should be able to follow basic instructions with minimal support and engage safely and respectfully in the kitchen. | Participation in our cooking class is not encouraged for individuals with food allergies, including but not limited to wheat and nuts. Ingredients are used throughout the facility, and cross-contamination cannot be guaranteed.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. *YesNoWe 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 PaymentPlease DO NOT use Secure, fast checkout with Link and proceed to enter card payment information. Total Order Summary Item Quantity Qty Total There are no products selected. Movement Circle: (4 Mondays from 4:00 -5:00 PM) - July 6 - July 271$60.00Art Circle: ( 4 Mondays from 5:00-6:00 PM) - July 6 - July 271$60.00Karate Circle: ( 4 Wednesdays from 4:00 - 5:00PM) - July 8- July 291$60.00FC Band (4 Wednesdays from 5:00-6:00) FREE - FC BAND1$0.00 Cooking Circle: (4 Thursdays from 5:00 - 6:00 PM) - July 9 - July 301$80.00Adult Social Group: (2 Tuesdays: 6:30 - 8:00PM)/ (1 Sunday: 1:30 - 4:30) - BOTH Tuesdays and Sundays1$70.00Adult Social Group: (2 Tuesdays: 6:30 - 8:00PM)/ (1 Sunday: 1:30 - 4:30) - Tuesday ONLY: July 7 & July 281$50.00Adult Social Group: (2 Tuesdays: 6:30 - 8:00PM)/ (1 Sunday: 1:30 - 4:30) - Sunday ONLY: July 191$30.00Adult Culinary Program: ( 4 Tuesday and 4 Thursday: 1:00-3:00PM) - Adult Culinary Program1$180.00SubtotalTotal$0.00 $0.00Parent's Name *FirstLastEnter Payment InformationPlease DO NOT use Secure, fast checkout with Link and proceed to enter card payment information. Submit
