Soccer Stars RSVP

Please contact Chanie Baitelman with any questions! 818-262-5016 or Info@ValleyFriendshipCircle.com

Full Name*

First Name Last Name

E-mail*

I would like to receive news and updates by email

Phone Number*

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Consent*

I permit my child's photos and videos to be used on social media for publicity purposes to assist the Valley Friendship Circle.I understand that it is necessary for me as parent(s)/guardian(s) to assume full oversight and supervision responsibilities with respect to all Valley Friendship Circle activitiesI agree to respect the privacy of all participants of the VFC and to keep personal information confidential.I understand and agree to, at all times have at least one parent/guardian “on premises” during the entirety the Friends@Home visitation program.I agree that the parent/guardian takes full responsibility for my child’s attendance and participation in the Soccer Stars Program and exempts the Valley Friendship Circle from any responsibility.I give my child permission to participate in the Valley Friendship Circle. I understand that participation in this activity is entirely voluntary and requires participants to abide by applicable rules and standards of conduct as set forth in above, as it may be modified from time to time. I understand that this local Valley Friendship Circle is an independent owned, operated and controlledI, myself and on behalf of my child, release the Valley Friendship Circle and its employees, directors, officers and volunteers as well as all other organizations associated with the VFC from any and all claims or liability arising out of this participation.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.

Signature of Parent/Guardian:*

Month Day Year

Emergency Contact*

First Name Last Name

Phone Number*

Relationship:*

I hereby give consent for my child to participate in all activities of Valley Friendship Circle Summer Circle both on and off site, trips, transportation to and from trips etc., unless I advise you otherwise in writing.

Signature of Parent/Guardian:*

Full Name

First Name Last Name

Choose dates:

$60 Fee Per Class

10 week sessions

Total

$0.00

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Soccer Stars Application

AGREEMENT:

Emergency Information:

PARENTAL CONSENT:

Friends @ Home

Volunteer Club

Virtual Friendship Fun

Parent Support Circle

MIND BODY & SOUL

Social Circle