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RVA Adaptive Athletics Day
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October Birthday Circle
Family Signup
2026 Adaptive Horseback Riding - Family Signup
Family
Name of Parent (s) / Caregiver
(Required)
First
Last
Name of Individual with disability
(Required)
Age of Individual with disability
(Required)
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Birthday Circles are designed for children with disabilities ages 12 and under. Teens with disabilities are also welcome to attend if their parents or caregivers feel the program would be a good fit for them.
Diagnosis of Individual with disability
(Required)
Name and age of Sibling(s) that will attending
Phone
(Required)
Email
(Required)
What timeslot will you be attending?
(Required)
1:00 - 2:30 PM
2:30 - 4:00 PM
I also need to sign up my teen who will be volunteering
Yes
No
Name of Teen Friend (Volunteer)
(Required)
First
Last
Age of Teen Friend
(Required)
12
13
14
15
16
17
18
19
20
21
General Information
Is this your first event with Friendship Circle of VA?
(Required)
Yes
No
Does someone in your group have a food allergy?
(Required)
Yes
No
Please list your food allergy
(Required)
Do you have any accessibility needs?
(Required)
Yes
No
Please specify you accessibility needs
(Required)
How did you hear about this event?
(Required)
Additional Comments
Donation
All of our events are normally free, so please consider a donation to help keep it that way for all of our families and friends.
Payment Details
Total
Payment Method
PayPal Checkout
Credit Card
American Express
MasterCard
Visa
Supported Credit Cards: American Express, MasterCard, Visa
Card Number
Expiration Date
Security Code
Δ