October Birthday Circle

Family Signup

The "Children 12 and under at 1 PM" timeslot is currently FULL. All new signups will be placed on a waitlist.

Adaptive Horseback Riding - Family Signup

Name of Parent (s) / Caregiver(Required)

First Last

Name of Individual with disability(Required)

Age of Individual with disability(Required)

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)

Children 12 and under at 1 PM (CURRENTLY FULL. ALL NEW SIGNUPS WILL BE PLACED ON A WAITLIST)

Children 13+ at 2:30 PM

I also need to sign up my teen who will be volunteering

Yes

Name of Teen Friend (Volunteer)(Required)

First Last

Age of Teen Friend(Required)

Is this your first event with Friendship Circle of VA?(Required)

Yes

Does someone in your group have a food allergy?(Required)

Yes

Please list your food allergy(Required)

Do you have any accessibility needs?(Required)

Yes

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.

Total

Payment Method

American Express

Discover

MasterCard

Visa

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

Card Number Expiration Date Security Code

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