Child Application

  • Child's Information

  • Parents Information

  • Emergency and Medical Contact Information

  • If parent cannot be reached and emergency medical advice is needed, permission is given to the Valley Friendship Circle staff to phone my child's doctor.

  • In case of medical emergency requiring immediate care, I authorize the Valley Friendship Circle staff and/or paramedics to take my child to the nearest hospital to receive medical care.

  • Pick a Date
  • $0.00
  • Credit Card
    Billing Address
  • Should be Empty:
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