** If you are new to Friendship Circle, please complete a registration form HERE in addition to this camp registration form. ** Section 1: Camper Information First Name Last Name Birthdate Gender Male FemaleOther Address City/State/Zip Primary Phone Second Phone Mother's Name Father's Name Mom's Daytime Phone Dad's Daytime Phone Email: How did you hear about us: Additional Information About your Camper Allergies Gluten Free: No Yes Dairy/Casein Free: No Yes Other food concerns: Is your child toilet trained? Yes Please let us know if there is any additional information we may need to make camp as comfortable and safe for your child as possible. This includes any behavior, diet, special updates, etc information... Section 2: Medication Information (if applicable) Name of Medication Dosage Dates Administered from to Specific time(s) and additional instructions Section 3: Registration and Payment Information My child will be attending on: Monday, June 15 Tuesday, June 16 Wednesday, June 17 Thursday, June 18 Friday, June 19 CAMP SCHEDULE: Monday: Bus trip to Tanaka Farms for strawberry picking (tentative) Tuesday: Mini Olympic Games at Campsite Wednesday: Bus trip to Ocean Institute and beach time in Dana Point Thursday: Bus trip to Castle Park in Riverside (late pickup at 4:00) Friday: Movie Day (Toy Story 5) at the Irvine Spectrum ONE t-shirt will be supplied with registration. Additional t-shirts are available for $10 each. Quantity: T-shirt size: Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult X-Large 1 2 3 4 5 selected="selected">5 days of camp @ $120 per day: Payment type cash check credit card Regional Center payment Card Type (if using cc) cost for t-shirts ($10 each, after the 1st): Card Number: CCV TOTAL OWED: Billing Zip Exp. Date Please type your name to verify registration: ** PLEASE NOTE: THERE WILL BE NO REFUNDS ISSUED AFTER MONDAY, JUNE 1, 2026 ** This page uses 128 bit SSL encryption to keep your data secure.
