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Sign Up for Our Next Birthday Circle!

Adaptive Gymnastics (3)

Adaptive Gymnastics

Email(Required)

Phone(Required)

I am signing up as a(Required)

Family with a child with a disability

Teen Friend (Volunteer to be paired with a child or teen w/a disability)

Family

Name of Parent (s) / Caregiver(Required)

First Last

Name of Individual with disability(Required)

Age of Individual with disability(Required)

Other

If other, please list here.

I also need to sign up sibling(s)

Yes

No

Diagnosis of Individual with disability(Required)

Siblings

List names and ages of all siblings attending and if they have a disability.

Teen Friend (Volunteer to be paired with a child w/a disability)

Name of Teen Friend (Volunteer)(Required)

First Last

Age of Teen Friend(Required)

Parent Name

First Last

Parent Phone

Parent Email

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)

Photo Consent

By checking this box, I give permission for my/my child’s image to be used by Friendship Circle of Virginia for social media and promotional purposes.

I acknowledge that photos of participants may be taken during this event.

Liability

By checking this box, I agree to the event liability waiver.

I acknowledge that participation is voluntary and that Friendship Circle of Virginia (FCVA) are not responsible or liable for any injuries, accidents, loss, or damages that may occur during the event. I agree to assume all risks associated with participation for myself/my child.

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

American Express

Discover

MasterCard

Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Card Number Expiration Date Security Code

Δ

Logo_New-QTS-1-300x117

candid-seal-platinum-2026

Contact

212 North Gaskins Road, Richmond, 23238
info@friendshipcircleva.org
804.740.2000 ext. 4

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