<!DOCTYPE HTML PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/html4/loose.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head id="Head1">
<meta http-equiv="X-UA-Compatible" content="IE=edge" />
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<meta http-equiv="Content-Language" content="en" />

<meta property="og:image" content="https://w2.chabad.org/media/images/1063/Seda10639346.jpg" itemprop="image" width="200" height="211" />
<meta property="og:image:width" content="200" />
<meta property="og:image:height" content="211" />
<meta name="keywords" content="2026-27,Registration" />
<meta name="title" content="2026-27 Registration - Ariella&#39;s NY Friendship Circle" />
<meta property="og:type" content="website" />
<meta name="scope-aids" content="2998844-2998846-5717883-3026556-3065628" />
<meta name="article-keywords" content="2185-6760-20429-1709-1674-2170-2898" />
<meta name="scope-aid" content="2998844" />
<meta name="scope-aid" content="2998846" />
<meta name="scope-aid" content="5717883" />
<meta name="scope-aid" content="3026556" />
<meta name="scope-aid" content="3065628" />
<meta name="article-keyword" content="2185" />
<meta name="article-keyword" content="6760" />
<meta name="article-keyword" content="20429" />
<meta name="article-keyword" content="1709" />
<meta name="article-keyword" content="1674" />
<meta name="article-keyword" content="2170" />
<meta name="article-keyword" content="2898" />
<meta property="og:url" content="https://www.nyfriendshipcircle.com/templates/articlecco_cdo/aid/3065628/jewish/2026-27-Registration.htm" />
<meta property="twitter:card" content="summary_large_image" />
<meta property="twitter:site" content="@chabad" />
<meta property="og:title" content="2026-27 Registration - Ariella&#39;s NY Friendship Circle" /><link rel="canonical" href="https://www.nyfriendshipcircle.com/templates/articlecco_cdo/aid/3065628/jewish/2026-27-Registration.htm" />
<link rel="image_src" href="https://w2.chabad.org/media/images/1063/Seda10639346.jpg" />
<link rel="Stylesheet" href="/css/fonts/font-awesome/font-awesome-5.css?v=2D6ABDDB" id="kfont-awesome" type="text/css"/>
<link rel="Stylesheet" href="/css/DefaultGrid.css?v=A13D74E8" id="kgrid" type="text/css"/>
<link rel="Stylesheet" href="/css/Elements.css?v=3A4C63F4" id="k6" type="text/css"/>
<link rel="Stylesheet" href="/css/vendor/ds/tokens/sites.css?v=72A49647" id="ksites-ds-css" type="text/css"/>
<link rel="Stylesheet" href="/css/new/main.css?v=BB63DD50" id="k7" type="text/css"/>
<link rel="Stylesheet" href="/css/cco/templates/FriendshipCircle2/bjqs.css?v=515CE4CD" id="kbjqs" type="text/css"/>
<link rel="Stylesheet" href="/css/fonts/ubuntu.css?v=63925769" id="kfonts" type="text/css"/>
<link rel="Stylesheet" href="/css/cco/templates/FriendshipCircle2/reset.css?v=78AA6E24" id="kreset" type="text/css"/>
<link rel="Stylesheet" href="/css/cco/templates/FriendshipCircle2/FriendshipCircle2.css?v=0694CE5A" id="k" type="text/css"/>
<link rel="Stylesheet" href="/css/old/global.css?v=43DDBA77" id="k2898" type="text/css"/>
<link rel="Stylesheet" href="/css/cco/templates/forms/formCss2.css?v=AB6A2925" id="kFormCss" type="text/css"/>
<link rel="Stylesheet" href="/css/cco/templates/forms/themes/nova.css?v=87AD6957" id="kNova" type="text/css"/>
<link rel="Stylesheet" href="/css/bootstrap/grid.css?v=F4390F2B" id="kbootstrap4-grid" type="text/css"/>
<link rel="Stylesheet" href="/css/Library/reader-comments.css?v=8AB57D79" id="kCommentsStylesheet" type="text/css"/>
<link rel="Stylesheet" href="/css/inline/BookInfo.css?v=3D052243" id="kBookInfoCss" type="text/css"/>

<script>$q=[];$j=function(f){$q.push(f);}</script>
	
<title>
	2026-27 Registration - Ariella's NY Friendship Circle
</title>
	



<script>
	window.dataLayer = window.dataLayer || [];
	dataLayer.push({"event":"datalayer-initialized","page":{"numberOfComments":0,"publicationDate":"2015-09-16","primaryArticleId":3065628,"title":"","author":"","authorId":0,"contentLevel1":"My Site","contentLevel2":"Participants","contentLevel3":"Participant Registration","contentLevel4":"2026-27 Registration","siteName":"Ariella's NY Friendship Circle"},"time":{"upcomingHoliday":"Yom Kippur","daysToUpcomingHoliday":2,"hebrewDate":"5787-07-08"}});
		dataLayer.push({ 'articleHierarchy': '-2998844-2998846-5717883-3026556-3065628-', 'keywords': '-k2898-k2170-k1674-k1709-k20429-k6760-k2185-', 'k': '-2998844-2998846-5717883-3026556-3065628--k2898-k2170-k1674-k1709-k20429-k6760-k2185-' });
	
</script>
<script>

(function(c,h,a,b,a,d){c[a]=c[a]||[];c[a].push({'gtm.start':
new Date().getTime(),event:'gtm.js'});var f=h.getElementsByTagName(b)[0],
j=h.createElement(b);j.async=true;
j.src='https://w6.chabad.org/mitzvah-tank.js';f.parentNode.insertBefore(j,f);
})(window,document,0,'script','dataLayer');</script>

	<!-- Start of StatCounter Code -->
	<script type="text/javascript">
	var sc_project = 10593156;var sc_partition = 94;var sc_invisible = 1;var sc_remove_link=1;var sc_security = "da6ac557";var sc_https = 1;
	</script>
	<script type="text/javascript" src="https://secure.statcounter.com/counter/counter_xhtml.js" defer async></script>
	<noscript><img src="//c95.statcounter.com/counter.php?sc_project=10593156&amp;java=0&amp;security=da6ac557&amp;invisible=1" border="0" /> </noscript>
	<!-- End of StatCounter Code -->


<!-- Global site tag (gtag.js) - Google Analytics -->


<style>
input[type="checkbox"] {position:static;}
input[type="checkbox"] + label::before {content:none;}
</style>
<script async src="https://www.googletagmanager.com/gtag/js?id=UA-194611068-2"></script><script>
  window.dataLayer = window.dataLayer || [];
  function gtag(){dataLayer.push(arguments);}
  gtag('js', new Date());

  gtag('config', 'UA-194611068-2');
</script></head>
<body class="lang_en dir_ltr cco_body form secure">
	
	


	<div id="header" class="clearfix">
		<div class="main">
			<h1 id="logo" class="g340"><a href="/">Ariella's NY Friendship Circle</a></h1>
			<div id="top-head" class="g620"> 
				<ul class="socials">
					<li class="facebook"><a href="https://www.facebook.com/FriendshipCircleSuffolk" target="_blank"><img src="https://w2.chabad.org/images/templates/fc2/ico-facebook.png" alt="facebook"></a></li>
					<li class="twiter"><a href="/cco_twitter" target="_blank"><img src="https://w2.chabad.org/images/templates/fc2/ico-twitter.png" alt="twitter"></a></li>
					<li class="donate"><a href="/3514580"><img src="https://w2.chabad.org/images/templates/fc2/bg-donate.png" alt="Donate"></a></li>
				</ul>
			</div>
			<div id="navigation" class="g620">
				

<div class="top_nav"><ul>
			<li>
				<a href="/article.asp?aid=3007058">
					
						<img src="https://w2.chabad.org/images/spacer.gif" alt="About Us" />
					
					<span>About Us</span>
				</a>
				<ul class="submenu"><li><a href="/article.asp?aid=4118351">Home</a></li><li><a href="/article.asp?aid=6773038">The Weekly Update</a></li><li><a href="/article.asp?aid=3007051">Parent Feedback</a></li><li><a href="/article.asp?aid=7446656">Resources</a></li><li><a href="/article.asp?aid=3761488">Contact</a></li></ul>
			</li>
		
			<li>
				<a href="/article.asp?aid=5717883">
					
						<img src="https://w2.chabad.org/images/spacer.gif" alt="Participants" />
					
					<span>Participants</span>
				</a>
				<ul class="submenu"><li><a href="/article.asp?aid=3026556">Participant Registration</a></li><li><a href="/article.asp?aid=5717932">Programs</a></li></ul>
			</li>
		
			<li>
				<a href="/article.asp?aid=4908896">
					
						<img src="https://w2.chabad.org/images/spacer.gif" alt="Volunteers" />
					
					<span>Volunteers</span>
				</a>
				<ul class="submenu"><li><a href="/article.asp?aid=3067568">Volunteer Application</a></li><li><a href="/article.asp?aid=5245855">Volunteer Program RSVP</a></li><li><a href="/article.asp?aid=5817287">Volunteer Leadership Board</a></li><li><a href="/article.asp?aid=5467617">2026-27 Volunteer Orientation</a></li></ul>
			</li>
		
			<li>
				<a href="/article.asp?aid=5717919">
					
						<img src="https://w2.chabad.org/images/spacer.gif" alt="Programs" />
					
					<span>Programs</span>
				</a>
				<ul class="submenu"><li><a href="/article.asp?aid=5841233">Fall 2026 Programs</a></li></ul>
			</li>
		
			<li>
				<a href="/article.asp?aid=3093899">
					
						<img src="https://w2.chabad.org/images/spacer.gif" alt="Photo Gallery" />
					
					<span>Photo Gallery</span>
				</a>
				<ul class="submenu"><li><a href="/article.asp?aid=7409482">2025</a></li><li><a href="/article.asp?aid=7409492">Photo Archives</a></li></ul>
			</li>
		</ul></div>
				
			</div>
		</div>
	</div>
	<div id="content">
		<div id="BodyContainer" class="wrapper">
			<div class="body_wrapper  clearfix">
				
	<div class="co_content_container clearfix local_content" id="co_content_container">
		<div class="clearfix">
			
			
			
			<div class="clearfix bh mobile-only align_right">ב"ה</div>
			
				<div class="master-content-wrapper g960" >
					

<header class="article-header cf ">
	
<script type="application/ld+json">
{
	"@context": "http://schema.org",
	"@type": "BreadcrumbList",
	"itemListElement": [
  {
    "@type": "ListItem",
    "position": 1,
    "item": {
      "@id": "/templates/articlecco_cdo/aid/5717883/jewish/Participants.htm",
      "name": "Participants"
    }
  },
  {
    "@type": "ListItem",
    "position": 2,
    "item": {
      "@id": "/templates/articlecco_cdo/aid/3026556/jewish/Participant-Registration.htm",
      "name": "Participant Registration"
    }
  },
  {
    "@type": "ListItem",
    "position": 3,
    "item": {
      "@id": "/article.asp?aid=3065628",
      "name": "2026-27 Registration"
    }
  }
]
}
</script>
<div class="breadcrumbs breadcrumbs hide_for_print" data-list-name="breadcrumbs">
	
			<a class="breadcrumbs__crumb" href='/templates/articlecco_cdo/aid/5717883/jewish/Participants.htm' data-aid="5717883">
				Participants
			</a>
		<span class="breadcrumbs__divider fa fa-angle-end"></span>
			<a class="breadcrumbs__crumb" href='/templates/articlecco_cdo/aid/3026556/jewish/Participant-Registration.htm' data-aid="3026556">
				Participant Registration
			</a>
		
</div>
	
			<h1 class="article-header__title js-article-title js-page-title">2026-27 Registration</h1>
		
			<div>
				
			</div>
		
</header>
				</div>
			
			<div class="body_wrapper clearfix co_body">
				<div class="g780" id="co_body_container">
					
					<div id="ContentBody">
						
						
							<div class="content-area-parent no_margin">
								
	<div id="cco_body">
		<div class="content g780 no_margin no_overflow" id="co_content_container">
			
			
	

	<article class="content js-content" >
	

<div id="formContainer"><script type="text/javascript">var defaultCurrency = { value: 'USD', symbol: '$'};
$j(function(){
window.multiplier = 0;
window.formJson = Object.extend([{"form_height":629,"1_text":"New York Friendship Circle Registration","1_subHeader":"Program Year 2026-27","1_headerType":"Large","1_name":"clickTo","1_qid":1,"1_type":"control_head","1_order":1,"3_text":"Participant Information","3_subHeader":"","3_headerType":"Small","3_name":"clickTo3","3_qid":3,"3_type":"control_head","3_order":2,"4_text":"Full Name","4_message":"","4_labelAlign":"Auto","4_required":"Yes","4_prefix":"No","4_suffix":"No","4_middle":"No","4_description":"","4_sublabels":{"prefix":"Prefix","first":"First Name","middle":"Middle Name","last":"Last Name","suffix":"Suffix"},"4_readonly":"No","4_name":"fullName4","4_qid":4,"4_type":"control_fullname","4_order":3,"5_text":"Gender","5_message":"","5_labelAlign":"Auto","5_required":"Yes","5_options":"Male|Female","5_special":"None","5_allowOther":"No","5_otherText":"Other","5_calculateOther":"No","5_selected":"","5_spreadCols":"2","5_description":"","5_name":"gender","5_qid":5,"5_type":"control_radio","5_order":4,"6_text":"Birth Date","6_message":"","6_labelAlign":"Auto","6_required":"Yes","6_format":"mmddyyyy","6_yearFrom":"","6_yearTo":"","6_months":[[],[],[],[],[],[],[],[],[],[],[],[]],"6_description":"","6_sublabels":{"month":"Month","day":"Day","year":"Year"},"6_name":"birthDate6","6_qid":6,"6_type":"control_birthdate","6_order":5,"7_text":"Lives with","7_message":"","7_labelAlign":"Auto","7_required":"Yes","7_options":"Both parents|Mom|Dad|Other","7_special":"None","7_allowOther":"No","7_otherText":"Other","7_calculateOther":"No","7_selected":"","7_spreadCols":"2","7_description":"","7_name":"livesWith","7_qid":7,"7_type":"control_radio","7_order":6,"90_text":"If lives with \"other,\" please specify here:","90_message":"","90_labelAlign":"Auto","90_required":"No","90_size":20,"90_validation":"None","90_maxsize":"","90_inputTextMask":"","90_defaultValue":"","90_subLabel":"","90_hint":" ","90_description":"","90_readonly":"No","90_name":"input90","90_qid":90,"90_type":"control_textbox","90_order":7,"132_text":"Is the Participant in Self Direction?","132_message":"","132_labelAlign":"Auto","132_required":"Yes","132_options":"Yes|No","132_special":"None","132_allowOther":"No","132_otherText":"Other","132_calculateOther":"No","132_selected":"","132_spreadCols":"2","132_description":"","132_name":"input132","132_qid":132,"132_type":"control_radio","132_order":8,"11_text":"Allergies","11_message":"","11_labelAlign":"Auto","11_required":"No","11_cols":40,"11_rows":6,"11_validation":"None","11_entryLimit":"None-0","11_maxsize":"","11_defaultValue":"","11_subLabel":"","11_hint":"","11_description":"leave blank if not applicable","11_readonly":"No","11_wysiwyg":"Disable","11_name":"allergies","11_qid":11,"11_type":"control_textarea","11_order":9,"89_text":"Are you a returning applicant?","89_message":"","89_labelAlign":"Auto","89_required":"Yes","89_options":"Yes|No","89_special":"None","89_allowOther":"No","89_otherText":"Other","89_calculateOther":"No","89_selected":"","89_spreadCols":"2","89_description":"","89_name":"input89","89_qid":89,"89_type":"control_radio","89_order":10,"14_text":"Parent/Guardian/Contact Person","14_subHeader":"","14_headerType":"Default","14_name":"clickTo14","14_qid":14,"14_type":"control_head","14_order":11,"15_text":"Parent/Guardian/Contact Person","15_message":"This is who will receive notifications from us","15_labelAlign":"Auto","15_required":"Yes","15_prefix":"No","15_suffix":"No","15_middle":"No","15_description":"","15_sublabels":{"prefix":"Prefix","first":"First Name","middle":"Middle Name","last":"Last Name","suffix":"Suffix"},"15_readonly":"No","15_name":"mothersName","15_qid":15,"15_type":"control_fullname","15_order":12,"123_text":"Relationship to applicant","123_message":"","123_labelAlign":"Auto","123_required":"Yes","123_options":"Mother|Father|Other","123_special":"None","123_allowOther":"No","123_otherText":"Other","123_calculateOther":"No","123_selected":"","123_spreadCols":"2","123_description":"","123_name":"input123","123_qid":123,"123_type":"control_radio","123_order":13,"124_text":"Please describe your relationship to the applicant","124_message":"","124_labelAlign":"Auto","124_required":"No","124_size":20,"124_validation":"None","124_maxsize":"","124_inputTextMask":"","124_defaultValue":"","124_subLabel":"","124_hint":" ","124_description":"","124_readonly":"No","124_name":"input124","124_qid":124,"124_type":"control_textbox","124_order":14,"17_text":"Cell Number","17_message":"","17_labelAlign":"Auto","17_required":"Yes","17_validation":"Numeric","17_countryCode":"No","17_inputMask":"disable","17_inputMaskValue":"(###) ###-####","17_description":"","17_sublabels":{"country":"Country Code","area":"Area Code","phone":"Phone Number","full":"Phone Number"},"17_readonly":"No","17_name":"cellNumber","17_qid":17,"17_type":"control_phone","17_order":15,"16_text":"Home Number","16_message":"","16_labelAlign":"Auto","16_required":"No","16_validation":"Numeric","16_countryCode":"No","16_inputMask":"disable","16_inputMaskValue":"(###) ###-####","16_description":"","16_sublabels":{"country":"Country Code","area":"Area Code","phone":"Phone Number","full":"Phone Number"},"16_readonly":"No","16_name":"homeNumber","16_qid":16,"16_type":"control_phone","16_order":16,"18_text":"Work Number","18_message":"","18_labelAlign":"Auto","18_required":"No","18_validation":"Numeric","18_countryCode":"No","18_inputMask":"disable","18_inputMaskValue":"(###) ###-####","18_description":"","18_sublabels":{"country":"Country Code","area":"Area Code","phone":"Phone Number","full":"Phone Number"},"18_readonly":"No","18_name":"workNumber","18_qid":18,"18_type":"control_phone","18_order":17,"19_receivesReceipts":"Yes","19_text":"E-mail","19_message":"","19_labelAlign":"Auto","19_required":"Yes","19_size":30,"19_validation":"Email","19_maxsize":"","19_defaultValue":"","19_subLabel":"","19_hint":"ex: myname@example.com","19_description":"","19_confirmation":"No","19_confirmationHint":"Confirm Email","19_readonly":"No","19_name":"email19","19_qid":19,"19_type":"control_email","19_order":18,"20_text":"Occuption","20_message":"","20_labelAlign":"Auto","20_required":"No","20_size":20,"20_validation":"None","20_maxsize":"","20_inputTextMask":"","20_defaultValue":"","20_subLabel":"","20_hint":" ","20_description":"","20_readonly":"No","20_name":"occuption","20_qid":20,"20_type":"control_textbox","20_order":19,"21_text":"Address","21_message":"","21_labelAlign":"Auto","21_required":"Yes","21_selectedCountry":"United States","21_description":"","21_subfields":"st1|st2|city|state|zip|country","21_sublabels":{"cc_firstName":"First Name","cc_lastName":"Last Name","cc_number":"Credit Card Number","cc_ccv":"Security Code","cc_exp_month":"Expiration Month","cc_exp_year":"Expiration Year","addr_line1":"Street Address","addr_line2":"Street Address Line 2","city":"City","state":"State / Province","postal":"Postal / Zip Code","country":"Country"},"21_name":"address21","21_qid":21,"21_type":"control_address","21_order":20,"130_text":"Are you interested in volunteer opportunities with The Friendship Circle?","130_message":"","130_labelAlign":"Auto","130_required":"No","130_options":"Check here","130_special":"None","130_allowOther":"No","130_otherText":"Other","130_calculateOther":"No","130_spreadCols":"1","130_selected":"","130_minSelection":"","130_maxSelection":"","130_description":"","130_name":"input130","130_qid":130,"130_type":"control_checkbox","130_order":21,"131_text":"Choose your area/s of interest:","131_message":"","131_labelAlign":"Auto","131_required":"No","131_options":"Volunteering at programs|Volunteering at Special Events|Fundraising","131_special":"None","131_allowOther":"Yes","131_otherText":"Other","131_calculateOther":"No","131_spreadCols":"1","131_selected":"","131_minSelection":"","131_maxSelection":"","131_description":"","131_name":"input131","131_qid":131,"131_type":"control_checkbox","131_order":22,"40_text":"Help us get to know your child/applicant","40_subHeader":"","40_headerType":"Default","40_name":"clickTo40","40_qid":40,"40_type":"control_head","40_order":23,"41_text":"What is your child/the applicant\u0027s primary mode of communication","41_message":"","41_labelAlign":"Auto","41_required":"Yes","41_options":"Verbal - Full sentences|Verbal - Words|Hand Gestures|Letter Board|Picture Board","41_special":"None","41_allowOther":"Yes","41_otherText":"Other","41_calculateOther":"No","41_selected":"","41_spreadCols":"1","41_description":"","41_name":"whatIs41","41_qid":41,"41_type":"control_radio","41_order":24,"44_text":"Are there any specific behaviors your child/the applicant has that we should be aware of?","44_message":"","44_labelAlign":"Auto","44_required":"Yes","44_options":"Shyness|Wandering|Tantrums|Hiding|Hair Pulling|Aggressiveness|Biting|None","44_special":"None","44_allowOther":"Yes","44_otherText":"Other","44_calculateOther":"No","44_selected":"","44_spreadCols":"1","44_description":"","44_name":"areThere","44_qid":44,"44_type":"control_radio","44_order":25,"127_text":"If you chose \"Other\", please provide details:","127_message":"","127_labelAlign":"Auto","127_required":"No","127_cols":40,"127_rows":6,"127_validation":"None","127_entryLimit":"None-0","127_maxsize":"","127_defaultValue":"","127_subLabel":"","127_hint":"","127_description":"","127_readonly":"No","127_wysiwyg":"Disable","127_name":"input127","127_qid":127,"127_type":"control_textarea","127_order":26,"72_text":"Does anything else upset your child/the applicant?","72_message":"","72_labelAlign":"Auto","72_required":"Yes","72_cols":40,"72_rows":6,"72_validation":"None","72_entryLimit":"None-0","72_maxsize":"","72_defaultValue":"","72_subLabel":"","72_hint":"","72_description":"","72_readonly":"No","72_wysiwyg":"Disable","72_name":"whatUpsets","72_qid":72,"72_type":"control_textarea","72_order":27,"46_text":"Medical and Emergency Information","46_subHeader":"","46_headerType":"Default","46_name":"clickTo46","46_qid":46,"46_type":"control_head","46_order":28,"10_text":"Diagnosis","10_message":"","10_labelAlign":"Auto","10_required":"No","10_size":20,"10_validation":"None","10_maxsize":"","10_inputTextMask":"","10_defaultValue":"","10_subLabel":"","10_hint":" ","10_description":"","10_readonly":"No","10_name":"diagnosis","10_qid":10,"10_type":"control_textbox","10_order":29,"73_text":"Any activities your child/ the applicant should not participate in due to limitation or medical condition","73_message":"","73_labelAlign":"Auto","73_required":"Yes","73_cols":40,"73_rows":6,"73_validation":"None","73_entryLimit":"None-0","73_maxsize":"","73_defaultValue":"","73_subLabel":"","73_hint":"","73_description":"","73_readonly":"No","73_wysiwyg":"Disable","73_name":"anyActivities","73_qid":73,"73_type":"control_textarea","73_order":30,"48_text":"Emergency Contact Name","48_message":"","48_labelAlign":"Auto","48_required":"Yes","48_size":20,"48_validation":"None","48_maxsize":"","48_inputTextMask":"","48_defaultValue":"","48_subLabel":"","48_hint":" ","48_description":"","48_readonly":"No","48_name":"emergencyContact","48_qid":48,"48_type":"control_textbox","48_order":31,"49_text":"Emergency Contact Number","49_message":"","49_labelAlign":"Auto","49_required":"Yes","49_validation":"Numeric","49_countryCode":"No","49_inputMask":"disable","49_inputMaskValue":"(###) ###-####","49_description":"","49_sublabels":{"country":"Country Code","area":"Area Code","phone":"Phone Number","full":"Phone Number"},"49_readonly":"No","49_name":"emergencyContact49","49_qid":49,"49_type":"control_phone","49_order":32,"50_text":"Emergency Contact Cell Number","50_message":"","50_labelAlign":"Auto","50_required":"No","50_validation":"Numeric","50_countryCode":"No","50_inputMask":"disable","50_inputMaskValue":"(###) ###-####","50_description":"","50_sublabels":{"country":"Country Code","area":"Area Code","phone":"Phone Number","full":"Phone Number"},"50_readonly":"No","50_name":"emergencyContact50","50_qid":50,"50_type":"control_phone","50_order":33,"51_text":"Relationship to Child/applicant","51_message":"","51_labelAlign":"Auto","51_required":"Yes","51_size":20,"51_validation":"None","51_maxsize":"","51_inputTextMask":"","51_defaultValue":"","51_subLabel":"","51_hint":" ","51_description":"","51_readonly":"No","51_name":"relationshipTo","51_qid":51,"51_type":"control_textbox","51_order":34,"74_text":"Does this person have permission to pick up your child/the applicant?","74_message":"","74_labelAlign":"Auto","74_required":"Yes","74_options":"Yes|No","74_special":"None","74_allowOther":"No","74_otherText":"Other","74_calculateOther":"No","74_selected":"","74_spreadCols":"2","74_description":"","74_name":"doesThis","74_qid":74,"74_type":"control_radio","74_order":35,"133_text":"Media Release Consent","133_subHeader":"","133_headerType":"Default","133_name":"clickTo133","133_qid":133,"133_type":"control_head","133_order":36,"134_text":"\u003cp\u003eI give permission for the New York Friendship Circle to photograph and/or record video of my child during Friendship Circle programs and events. I understand that these images and videos may be used on the organization\u0026rsquo;s website, social media platforms, and in print materials to promote the mission and activities of the Friendship Circle. I understand that names of participants are NEVER used.\u003c/p\u003e\n","134_name":"doubleclickTo","134_qid":134,"134_type":"control_text","134_order":37,"135_text":"Please select one:","135_message":"","135_labelAlign":"Auto","135_required":"No","135_options":"Yes, I give permission|No, I do not give permission (please view our Instagram or Facebook page before choosing this option)","135_special":"None","135_allowOther":"No","135_otherText":"Other","135_calculateOther":"No","135_selected":"","135_spreadCols":"1","135_description":"","135_name":"input135","135_qid":135,"135_type":"control_radio","135_order":38,"136_text":"Waiver of Liability","136_subHeader":"","136_headerType":"Default","136_name":"clickTo136","136_qid":136,"136_type":"control_head","136_order":39,"137_text":"\u003cdiv style=\"text-align:start\"\u003e\u003cspan style=\"font-size:small\"\u003e\u003cspan style=\"color:#222222\"\u003e\u003cspan style=\"font-family:Arial, Helvetica, sans-serif\"\u003e\u003cspan style=\"font-style:normal\"\u003e\u003cspan style=\"font-variant-ligatures:normal\"\u003e\u003cspan style=\"font-weight:400\"\u003e\u003cspan style=\"white-space:normal\"\u003e\u003cspan style=\"background-color:#ffffff\"\u003e\u003cspan style=\"text-decoration-thickness:initial\"\u003e\u003cspan style=\"text-decoration-style:initial\"\u003e\u003cspan style=\"text-decoration-color:initial\"\u003e\u003cspan style=\"background-color:#ffffff\"\u003e\u003cfont color=\"#000000\"\u003e\u003cspan style=\"font-size:14px\"\u003e\u003cspan style=\"font-family:Arial, \u0026#34;Lucida Grande\u0026#34;, \u0026#34;Lucida Sans Unicode\u0026#34;, \u0026#34;Lucida Sans\u0026#34;, Verdana, Tahoma, sans-serif\"\u003eI give permission for the participant named above to participate in Friendship Circle events, including but not limited to: bowling, music, art, cooking, hip hop dance, sports, zumba and any other programs sponsored or run by the New York Friendship Circle.\u003c/span\u003e\u003c/span\u003e\u003c/font\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003cbr\u003e\n\u0026nbsp;\u003c/div\u003e\n\n\u003cdiv style=\"text-align:start\"\u003e\u003cspan style=\"font-size:small\"\u003e\u003cspan style=\"color:#222222\"\u003e\u003cspan style=\"font-family:Arial, Helvetica, sans-serif\"\u003e\u003cspan style=\"font-style:normal\"\u003e\u003cspan style=\"font-variant-ligatures:normal\"\u003e\u003cspan style=\"font-weight:400\"\u003e\u003cspan style=\"white-space:normal\"\u003e\u003cspan style=\"background-color:#ffffff\"\u003e\u003cspan style=\"text-decoration-thickness:initial\"\u003e\u003cspan style=\"text-decoration-style:initial\"\u003e\u003cspan style=\"text-decoration-color:initial\"\u003e\u003cspan style=\"background-color:#ffffff\"\u003e\u003cfont color=\"#000000\"\u003e\u003cspan style=\"font-size:14px\"\u003e\u003cspan style=\"font-family:Arial, \u0026#34;Lucida Grande\u0026#34;, \u0026#34;Lucida Sans Unicode\u0026#34;, \u0026#34;Lucida Sans\u0026#34;, Verdana, Tahoma, sans-serif\"\u003eI hereby\u0026nbsp;waive and release NY Friendship Circle and The Chai Center, their officers, directors, instructors, volunteers and any affiliates from The Chai Center or other organizations providing services to The Chai Center or the NY Friendship Circle from any claims of liability, including accidents, injury, or loss of personal property while participating in any events hosted or sponsored by the NY Friendship Circle and/or The Chai Center on or off their premises.\u003c/span\u003e\u003c/span\u003e\u003c/font\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003cbr\u003e\n\u0026nbsp;\u003c/div\u003e\n\n\u003cdiv style=\"text-align:start\"\u003e\u003cspan style=\"font-size:small\"\u003e\u003cspan style=\"color:#222222\"\u003e\u003cspan style=\"font-family:Arial, Helvetica, sans-serif\"\u003e\u003cspan style=\"font-style:normal\"\u003e\u003cspan style=\"font-variant-ligatures:normal\"\u003e\u003cspan style=\"font-weight:400\"\u003e\u003cspan style=\"white-space:normal\"\u003e\u003cspan style=\"background-color:#ffffff\"\u003e\u003cspan style=\"text-decoration-thickness:initial\"\u003e\u003cspan style=\"text-decoration-style:initial\"\u003e\u003cspan style=\"text-decoration-color:initial\"\u003e\u003cspan style=\"font-size:14px\"\u003e\u003cspan style=\"font-family:Arial, \u0026#34;Lucida Grande\u0026#34;, \u0026#34;Lucida Sans Unicode\u0026#34;, \u0026#34;Lucida Sans\u0026#34;, Verdana, Tahoma, sans-serif\"\u003e\u003cspan style=\"background-color:#ffffff\"\u003e\u003cfont color=\"#000000\"\u003eThis acknowledgment of risk and waiver of liability has been read, understood completely, and signed voluntarily by the parent / legal guardian of the participant listed above.\u003c/font\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/div\u003e\n","137_name":"doubleclickTo137","137_qid":137,"137_type":"control_text","137_order":40,"68_text":"Signature","68_message":"","68_labelAlign":"Auto","68_required":"Yes","68_size":20,"68_validation":"None","68_maxsize":"","68_inputTextMask":"","68_defaultValue":"","68_subLabel":"I understand typing my name here will be considered the same as my legal signature.","68_hint":" ","68_description":"","68_readonly":"No","68_name":"signature","68_qid":68,"68_type":"control_textbox","68_order":41,"69_text":"Date of Application","69_message":"","69_labelAlign":"Auto","69_required":"No","69_format":"mmddyyyy","69_allowTime":"No","69_timeFormat":"AM/PM","69_showDayPeriods":"both","69_defaultTime":"Yes","69_onlyFuture":"No","69_step":"10","69_autoCalendar":"Yes","69_description":"","69_startWeekOn":"Sunday","69_sublabels":{"day":"Day","month":"Month","year":"Year","last":"Last Name","hour":"Hour","minutes":"Minutes"},"69_name":"dateOf","69_qid":69,"69_type":"control_datetime","69_order":42,"121_text":"How did you hear about The Friendship Circle?","121_message":"","121_labelAlign":"Auto","121_required":"No","121_cols":40,"121_rows":6,"121_validation":"None","121_entryLimit":"None-0","121_maxsize":"","121_defaultValue":"","121_subLabel":"","121_hint":"","121_description":"","121_readonly":"No","121_wysiwyg":"Disable","121_name":"input121","121_qid":121,"121_type":"control_textarea","121_order":43,"2_text":"Submit","2_buttonAlign":"Auto","2_clear":"No","2_print":"No","2_name":"submit","2_qid":2,"2_type":"control_button","2_order":44,"form_title":"New York Friendship Circle Family Application","form_pagetitle":"Form","form_styles":"nova","form_font":"","form_fontsize":"14","form_fontcolor":"","form_optioncolor":"","form_lineSpacing":"12","form_background":"","form_formWidth":"765","form_labelWidth":"250","form_alignment":"Left","form_thankurl":"","form_thanktext":"","form_highlightLine":"Enabled","form_activeRedirect":"default","form_sendpostdata":"No","form_unique":"None","form_uniqueField":"\u003cField Id\u003e","form_status":"Enabled","form_injectCSS":"","form_hideMailEmptyFields":"disable","form_showProgressBar":"disable","form_formStrings":[{"required":"This field is required","requireOne":"At least one field required","requireEveryRow":"Every row is required","alphabetic":"This field can only contain letters","numeric":"This field can only contain numeric values","alphanumeric":"This field can only contain letters and numbers","incompleteFields":"There are incomplete required fields. Please complete them.","uploadFilesize":"File size cannot be bigger than:","confirmClearForm":"Are you sure you want to clear the form?","lessThan":"Your score should be less than or equal to","email":"Enter a valid e-mail address","uploadExtensions":"You can only upload following files:","pleaseWait":"Please wait...","confirmEmail":"E-mail does not match","submissionLimit":"Sorry! Only one entry is allowed.  Multiple submissions are disabled for this form.","gradingScoreError":"Score total should only be less than or equal to","inputCarretErrorA":"Input should not be less than the minimum value:","inputCarretErrorB":"Input should not be greater than the maximum value:","maxDigitsError":"The maximum digits allowed is","minSelectionsError":"The minimum required number of selections is","maxSelectionsError":"The maximum number of selections allowed is","pastDatesDisallowed":"Date must not be in the past","multipleFileUploads_typeError":"{file} has invalid extension. Only {extensions} are allowed.","multipleFileUploads_sizeError":"{file} is too large, maximum file size is {sizeLimit}.","multipleFileUploads_minSizeError":"{file} is too small, minimum file size is {minSizeLimit}.","multipleFileUploads_emptyError":"{file} is empty, please select files again without it.","multipleFileUploads_onLeave":"The files are being uploaded, if you leave now the upload will be cancelled.","generalError":"There are errors on the form. Please fix them before continuing.","generalPageError":"There are errors on this page. Please fix them before continuing."}],"form_limitSubmission":"No Limit","form_expireDate":"No Limit","form_messageOfLimitedForm":"This form is currently unavailable!","form_emails":[],"form_language":"","form_id":3065628,"form_style":"Default","form_theme":"nova","form_header":"","form_footer":"","form_sendEmail":"No","form_stopHighlight":"Yes","form_formStringsChanged":"yes","form_slug":3065628,"form_optinDisabled":"true","form_conditions":[{"type":"field","link":"Any","terms":[{"field":"123","operator":"equals","value":"Other"}],"actions":[{"field":"124","visibility":"Show"}]},{"type":"field","link":"Any","terms":[{"field":"130","operator":"isFilled","value":false}],"actions":[{"field":"131","visibility":"Show"}]},{"type":"field","link":"Any","terms":[{"field":"7","operator":"equals","value":"Other"}],"actions":[{"field":"90","visibility":"Show"}]}]}][0] || {}, window.formJson || {});
window.isSecureForm = true
});

			if (typeof(Userform) ==='undefined')
			{
				Userform={init:function(args){
					$j(function(){
						Userform.init.apply(Userform, [args]);
					})
				},
				setConditions:function(args){
					$j(function(){
						Userform.setConditions.apply(Userform, [args]);
					})
				}};
			}
</script><script type="text/javascript">
   Userform.setConditions([{"type":"field","link":"Any","terms":[{"field":"123","operator":"equals","value":"Other"}],"actions":[{"field":"124","visibility":"Show"}]},{"type":"field","link":"Any","terms":[{"field":"130","operator":"isFilled","value":false}],"actions":[{"field":"131","visibility":"Show"}]},{"type":"field","link":"Any","terms":[{"field":"7","operator":"equals","value":"Other"}],"actions":[{"field":"90","visibility":"Show"}]}]);
   Userform.init(function(){
      Userform.description('input_11', 'leave blank if not applicable');
      $('input_19').hint('ex: myname@example.com');
      Userform.setCalendar("69", false);
      Userform.displayLocalTime("hour_69", "min_69", "ampm_69");
      Userform.alterTexts({"required":"This field is required","requireOne":"At least one field required","requireEveryRow":"Every row is required","alphabetic":"This field can only contain letters","numeric":"This field can only contain numeric values","alphanumeric":"This field can only contain letters and numbers","incompleteFields":"There are incomplete required fields. Please complete them.","uploadFilesize":"File size cannot be bigger than:","confirmClearForm":"Are you sure you want to clear the form?","lessThan":"Your score should be less than or equal to","email":"Enter a valid e-mail address","uploadExtensions":"You can only upload following files:","pleaseWait":"Please wait...","confirmEmail":"E-mail does not match","submissionLimit":"Sorry! Only one entry is allowed.  Multiple submissions are disabled for this form.","gradingScoreError":"Score total should only be less than or equal to","inputCarretErrorA":"Input should not be less than the minimum value:","inputCarretErrorB":"Input should not be greater than the maximum value:","maxDigitsError":"The maximum digits allowed is","minSelectionsError":"The minimum required number of selections is","maxSelectionsError":"The maximum number of selections allowed is","pastDatesDisallowed":"Date must not be in the past","multipleFileUploads_typeError":"{file} has invalid extension. Only {extensions} are allowed.","multipleFileUploads_sizeError":"{file} is too large, maximum file size is {sizeLimit}.","multipleFileUploads_minSizeError":"{file} is too small, minimum file size is {minSizeLimit}.","multipleFileUploads_emptyError":"{file} is empty, please select files again without it.","multipleFileUploads_onLeave":"The files are being uploaded, if you leave now the upload will be cancelled.","generalError":"There are errors on the form. Please fix them before continuing.","generalPageError":"There are errors on this page. Please fix them before continuing."});
   });
</script>
<style type="text/css" id="GenFormStyles">
    .form-label{
        width:250px !important;
    }
    .form-label-left{
        width:250px !important;
    }
    .form-line{
        padding-top:12px;
        padding-bottom:12px;
    }
    .form-label-right{
        width:250px !important;
    }
    .form-all {
        font-size:14px;
    }
.co_body .content .form-all p {
 font-size:14px;

}
@media screen and (max-width: 700px) {.form-label-left{	float:none;	display:block;}.form-buttons-wrapper.button-align-auto{text-indent: 0!important;}}</style>

<form class="userform-form" action="" method="post" name="form_3065628" id="3065628" accept-charset="utf-8"><input type="hidden" name="formID" value="3065628" /><div class="form-all dir_ltr" dir="ltr"><ul class="form-section"><li id="cid_1" class="form-input-wide"> <div class="form-header-group"><h1 id="header_1" class="form-header">New York Friendship Circle Registration</h1><div id="subHeader_1" class="form-subHeader">Program Year 2026-27</div></div> </li><li id="cid_3" class="form-input-wide"> <div class="form-header-group"><h3 id="header_3" class="form-header">Participant Information</h3></div> </li><li class="form-line" id="id_4"><div class="form-label-left" id="label_4"><label for="input_4"> Full Name<span class="form-required">*</span> </label><label class="label-message" for="input_4"> </label></div><div id="cid_4" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q4_fullName4[first]" id="first_4" autocomplete="given-name" />  <label class="form-sub-label" for="first_4" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q4_fullName4[last]" id="last_4" autocomplete="family-name" />  <label class="form-sub-label" for="last_4" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_5"><div class="form-label-left" id="label_5"><label for="input_5"> Gender<span class="form-required">*</span> </label><label class="label-message" for="input_5"> </label></div><div id="cid_5" class="form-input"> <div class="form-multiple-column"><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_5_0" name="q5_gender" value="Male" /><label id="label_input_5_0" for="input_5_0"><span>Male</span></label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_5_1" name="q5_gender" value="Female" /><label id="label_input_5_1" for="input_5_1"><span>Female</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_6"><div class="form-label-left" id="label_6"><label for="input_6"> Birth Date<span class="form-required">*</span> </label><label class="label-message" for="input_6"> </label></div><div id="cid_6" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown validate[required]" name="q6_birthDate6[month]" id="input_6_month"><option></option><option value="1">1 - January</option><option value="2">2 - February</option><option value="3">3 - March</option><option value="4">4 - April</option><option value="5">5 - May</option><option value="6">6 - June</option><option value="7">7 - July</option><option value="8">8 - August</option><option value="9">9 - September</option><option value="10">10 - October</option><option value="11">11 - November</option><option value="12">12 - December</option></select>  <label class="form-sub-label" for="input_6_month" id="sublabel_month">Month</label></span><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown validate[required]" name="q6_birthDate6[day]" id="input_6_day"><option></option><option value="1">1</option><option value="2">2</option><option value="3">3</option><option value="4">4</option><option value="5">5</option><option value="6">6</option><option value="7">7</option><option value="8">8</option><option value="9">9</option><option value="10">10</option><option value="11">11</option><option value="12">12</option><option value="13">13</option><option value="14">14</option><option value="15">15</option><option value="16">16</option><option value="17">17</option><option value="18">18</option><option value="19">19</option><option value="20">20</option><option value="21">21</option><option value="22">22</option><option value="23">23</option><option value="24">24</option><option value="25">25</option><option value="26">26</option><option value="27">27</option><option value="28">28</option><option value="29">29</option><option value="30">30</option><option value="31">31</option></select>  <label class="form-sub-label" for="input_6_day" id="sublabel_day">Day</label></span><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown validate[required]" name="q6_birthDate6[year]" id="input_6_year"><option></option><option value="2026">2026</option><option value="2025">2025</option><option value="2024">2024</option><option value="2023">2023</option><option value="2022">2022</option><option value="2021">2021</option><option value="2020">2020</option><option value="2019">2019</option><option value="2018">2018</option><option value="2017">2017</option><option value="2016">2016</option><option value="2015">2015</option><option value="2014">2014</option><option value="2013">2013</option><option value="2012">2012</option><option value="2011">2011</option><option value="2010">2010</option><option value="2009">2009</option><option value="2008">2008</option><option value="2007">2007</option><option value="2006">2006</option><option value="2005">2005</option><option value="2004">2004</option><option value="2003">2003</option><option value="2002">2002</option><option value="2001">2001</option><option value="2000">2000</option><option value="1999">1999</option><option value="1998">1998</option><option value="1997">1997</option><option value="1996">1996</option><option value="1995">1995</option><option value="1994">1994</option><option value="1993">1993</option><option value="1992">1992</option><option value="1991">1991</option><option value="1990">1990</option><option value="1989">1989</option><option value="1988">1988</option><option value="1987">1987</option><option value="1986">1986</option><option value="1985">1985</option><option value="1984">1984</option><option value="1983">1983</option><option value="1982">1982</option><option value="1981">1981</option><option value="1980">1980</option><option value="1979">1979</option><option value="1978">1978</option><option value="1977">1977</option><option value="1976">1976</option><option value="1975">1975</option><option value="1974">1974</option><option value="1973">1973</option><option value="1972">1972</option><option value="1971">1971</option><option value="1970">1970</option><option value="1969">1969</option><option value="1968">1968</option><option value="1967">1967</option><option value="1966">1966</option><option value="1965">1965</option><option value="1964">1964</option><option value="1963">1963</option><option value="1962">1962</option><option value="1961">1961</option><option value="1960">1960</option><option value="1959">1959</option><option value="1958">1958</option><option value="1957">1957</option><option value="1956">1956</option><option value="1955">1955</option><option value="1954">1954</option><option value="1953">1953</option><option value="1952">1952</option><option value="1951">1951</option><option value="1950">1950</option><option value="1949">1949</option><option value="1948">1948</option><option value="1947">1947</option><option value="1946">1946</option><option value="1945">1945</option><option value="1944">1944</option><option value="1943">1943</option><option value="1942">1942</option><option value="1941">1941</option><option value="1940">1940</option><option value="1939">1939</option><option value="1938">1938</option><option value="1937">1937</option><option value="1936">1936</option><option value="1935">1935</option><option value="1934">1934</option><option value="1933">1933</option><option value="1932">1932</option><option value="1931">1931</option><option value="1930">1930</option><option value="1929">1929</option><option value="1928">1928</option><option value="1927">1927</option><option value="1926">1926</option><option value="1925">1925</option><option value="1924">1924</option><option value="1923">1923</option><option value="1922">1922</option><option value="1921">1921</option><option value="1920">1920</option></select>  <label class="form-sub-label" for="input_6_year" id="sublabel_year">Year</label></span></div> </div></li><li class="form-line" id="id_7"><div class="form-label-left" id="label_7"><label for="input_7"> Lives with<span class="form-required">*</span> </label><label class="label-message" for="input_7"> </label></div><div id="cid_7" class="form-input"> <div class="form-multiple-column"><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_7_0" name="q7_livesWith" value="Both parents" /><label id="label_input_7_0" for="input_7_0"><span>Both parents</span></label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_7_1" name="q7_livesWith" value="Mom" /><label id="label_input_7_1" for="input_7_1"><span>Mom</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_7_2" name="q7_livesWith" value="Dad" /><label id="label_input_7_2" for="input_7_2"><span>Dad</span></label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_7_3" name="q7_livesWith" value="Other" /><label id="label_input_7_3" for="input_7_3"><span>Other</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_90"><div class="form-label-left" id="label_90"><label for="input_90"> If lives with "other," please specify here: </label><label class="label-message" for="input_90"> </label></div><div id="cid_90" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_90" name="q90_input90" size="20" value="" /> </div></li><li class="form-line" id="id_132"><div class="form-label-left" id="label_132"><label for="input_132"> Is the Participant in Self Direction?<span class="form-required">*</span> </label><label class="label-message" for="input_132"> </label></div><div id="cid_132" class="form-input"> <div class="form-multiple-column"><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_132_0" name="q132_input132" value="Yes" /><label id="label_input_132_0" for="input_132_0"><span>Yes</span></label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_132_1" name="q132_input132" value="No" /><label id="label_input_132_1" for="input_132_1"><span>No</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_11"><div class="form-label-left" id="label_11"><label for="input_11"> Allergies </label><label class="label-message" for="input_11"> </label></div><div id="cid_11" class="form-input"> <textarea id="input_11" class="form-textarea" name="q11_allergies" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_89"><div class="form-label-left" id="label_89"><label for="input_89"> Are you a returning applicant?<span class="form-required">*</span> </label><label class="label-message" for="input_89"> </label></div><div id="cid_89" class="form-input"> <div class="form-multiple-column"><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_89_0" name="q89_input89" value="Yes" /><label id="label_input_89_0" for="input_89_0"><span>Yes</span></label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_89_1" name="q89_input89" value="No" /><label id="label_input_89_1" for="input_89_1"><span>No</span></label></span><span class="clearfix"></span></div> </div></li><li id="cid_14" class="form-input-wide"> <div class="form-header-group"><h2 id="header_14" class="form-header">Parent/Guardian/Contact Person</h2></div> </li><li class="form-line" id="id_15"><div class="form-label-left" id="label_15"><label for="input_15"> Parent/Guardian/Contact Person<span class="form-required">*</span> </label><label class="label-message" for="input_15"> This is who will receive notifications from us</label></div><div id="cid_15" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q15_mothersName[first]" id="first_15" autocomplete="given-name" />  <label class="form-sub-label" for="first_15" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q15_mothersName[last]" id="last_15" autocomplete="family-name" />  <label class="form-sub-label" for="last_15" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_123"><div class="form-label-left" id="label_123"><label for="input_123"> Relationship to applicant<span class="form-required">*</span> </label><label class="label-message" for="input_123"> </label></div><div id="cid_123" class="form-input"> <div class="form-multiple-column"><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_123_0" name="q123_input123" value="Mother" /><label id="label_input_123_0" for="input_123_0"><span>Mother</span></label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_123_1" name="q123_input123" value="Father" /><label id="label_input_123_1" for="input_123_1"><span>Father</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_123_2" name="q123_input123" value="Other" /><label id="label_input_123_2" for="input_123_2"><span>Other</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_124"><div class="form-label-left" id="label_124"><label for="input_124"> Please describe your relationship to the applicant </label><label class="label-message" for="input_124"> </label></div><div id="cid_124" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_124" name="q124_input124" size="20" value="" /> </div></li><li class="form-line" id="id_17"><div class="form-label-left" id="label_17"><label for="input_17"> Cell Number<span class="form-required">*</span> </label><label class="label-message" for="input_17"> </label></div><div id="cid_17" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><input class="form-textbox validate[required, Numeric]" type="tel" name="q17_cellNumber[area]" id="input_17_area" autocomplete="tel-area-code" maxlength="5" size="3" />  <label class="form-sub-label" for="input_17_area" id="sublabel_area">Area Code</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required, Numeric]" type="tel" name="q17_cellNumber[phone]" id="input_17_phone" autocomplete="tel-local" size="8" />  <label class="form-sub-label" for="input_17_phone" id="sublabel_phone">Phone Number</label></span></div> </div></li><li class="form-line" id="id_16"><div class="form-label-left" id="label_16"><label for="input_16"> Home Number </label><label class="label-message" for="input_16"> </label></div><div id="cid_16" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><input class="form-textbox validate[Numeric]" type="tel" name="q16_homeNumber[area]" id="input_16_area" autocomplete="tel-area-code" maxlength="5" size="3" />  <label class="form-sub-label" for="input_16_area" id="sublabel_area">Area Code</label></span><span class="form-sub-label-container"><input class="form-textbox validate[Numeric]" type="tel" name="q16_homeNumber[phone]" id="input_16_phone" autocomplete="tel-local" size="8" />  <label class="form-sub-label" for="input_16_phone" id="sublabel_phone">Phone Number</label></span></div> </div></li><li class="form-line" id="id_18"><div class="form-label-left" id="label_18"><label for="input_18"> Work Number </label><label class="label-message" for="input_18"> </label></div><div id="cid_18" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><input class="form-textbox validate[Numeric]" type="tel" name="q18_workNumber[area]" id="input_18_area" autocomplete="tel-area-code" maxlength="5" size="3" />  <label class="form-sub-label" for="input_18_area" id="sublabel_area">Area Code</label></span><span class="form-sub-label-container"><input class="form-textbox validate[Numeric]" type="tel" name="q18_workNumber[phone]" id="input_18_phone" autocomplete="tel-local" size="8" />  <label class="form-sub-label" for="input_18_phone" id="sublabel_phone">Phone Number</label></span></div> </div></li><li class="form-line" id="id_19"><div class="form-label-left" id="label_19"><label for="input_19"> E-mail<span class="form-required">*</span> </label><label class="label-message" for="input_19"> </label></div><div id="cid_19" class="form-input"> <input type="email" class=" form-textbox validate[required, Email]" id="input_19" name="q19_email19" size="30" value="" autocomplete="email" /> </div></li><li class="form-line" id="id_20"><div class="form-label-left" id="label_20"><label for="input_20"> Occuption </label><label class="label-message" for="input_20"> </label></div><div id="cid_20" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_20" name="q20_occuption" size="20" value="" /> </div></li><li class="form-line" id="id_21"><div class="form-label-left" id="label_21"><label for="input_21"> Address<span class="form-required">*</span> </label><label class="label-message" for="input_21"> </label></div><div id="cid_21" class="form-input"> <table summary="" class="form-address-table" border="0" cellpadding="0" cellspacing="0"><tbody><tr><td colspan="2"><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-line" type="text" name="q21_address21[addr_line1]" id="input_21_addr_line1" size="46" autocomplete="address-line1" />  <label class="form-sub-label" for="input_21_addr_line1" id="sublabel_21_addr_line1">Street Address</label></span></td></tr><tr><td colspan="2"><span class="form-sub-label-container"><input class="form-textbox form-address-line no-validation" type="text" name="q21_address21[addr_line2]" id="input_21_addr_line2" size="46" autocomplete="address-line2" />  <label class="form-sub-label" for="input_21_addr_line2" id="sublabel_21_addr_line2">Street Address Line 2</label></span></td></tr><tr><td width="50%"><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-city" type="text" name="q21_address21[city]" id="input_21_city" size="21" autocomplete="address-level2" />  <label class="form-sub-label" for="input_21_city" id="sublabel_21_city">City</label></span></td><td><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-state" type="text" name="q21_address21[state]" id="input_21_state" size="22" autocomplete="address-level1" />  <label class="form-sub-label" for="input_21_state" id="sublabel_21_state">State / Province</label></span></td></tr><tr><td width="50%"><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-postal" type="text" name="q21_address21[postal]" id="input_21_postal" size="10" autocomplete="postal-code" />  <label class="form-sub-label" for="input_21_postal" id="sublabel_21_postal">Postal / Zip Code</label></span></td><td><span class="form-sub-label-container"><select class="form-dropdown validate[required] form-address-country" name="q21_address21[country]" id="input_21_country" autocomplete="country-name"><option value="" selected="selected">Please Select</option><option selected="selected" value="United States">United States</option><option value="Afghanistan">Afghanistan</option><option value="Albania">Albania</option><option value="Algeria">Algeria</option><option value="American Samoa">American Samoa</option><option value="Andorra">Andorra</option><option value="Angola">Angola</option><option value="Anguilla">Anguilla</option><option value="Antigua and Barbuda">Antigua and Barbuda</option><option value="Argentina">Argentina</option><option value="Armenia">Armenia</option><option value="Aruba">Aruba</option><option value="Australia">Australia</option><option value="Austria">Austria</option><option value="Azerbaijan">Azerbaijan</option><option value="The Bahamas">The Bahamas</option><option value="Bahrain">Bahrain</option><option value="Bangladesh">Bangladesh</option><option value="Barbados">Barbados</option><option value="Belarus">Belarus</option><option value="Belgium">Belgium</option><option value="Belize">Belize</option><option value="Benin">Benin</option><option value="Bermuda">Bermuda</option><option value="Bhutan">Bhutan</option><option value="Bolivia">Bolivia</option><option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option><option value="Botswana">Botswana</option><option value="Brazil">Brazil</option><option value="Brunei">Brunei</option><option value="Bulgaria">Bulgaria</option><option value="Burkina Faso">Burkina Faso</option><option value="Burundi">Burundi</option><option value="Cambodia">Cambodia</option><option value="Cameroon">Cameroon</option><option value="Canada">Canada</option><option value="Cape Verde">Cape Verde</option><option value="Cayman Islands">Cayman Islands</option><option value="Central African Republic">Central African Republic</option><option value="Chad">Chad</option><option value="Chile">Chile</option><option value="People's Republic of China">People's Republic of China</option><option value="Republic of China">Republic of China</option><option value="Christmas Island">Christmas Island</option><option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option><option value="Colombia">Colombia</option><option value="Comoros">Comoros</option><option value="Congo">Congo</option><option value="Cook Islands">Cook Islands</option><option value="Costa Rica">Costa Rica</option><option value="Cote d'Ivoire">Cote d'Ivoire</option><option value="Croatia">Croatia</option><option value="Cuba">Cuba</option><option value="Cyprus">Cyprus</option><option value="Czech Republic">Czech Republic</option><option value="Denmark">Denmark</option><option value="Djibouti">Djibouti</option><option value="Dominica">Dominica</option><option value="Dominican Republic">Dominican Republic</option><option value="Ecuador">Ecuador</option><option value="Egypt">Egypt</option><option value="El Salvador">El Salvador</option><option value="Equatorial Guinea">Equatorial Guinea</option><option value="Eritrea">Eritrea</option><option value="Estonia">Estonia</option><option value="Eswatini">Eswatini</option><option value="Ethiopia">Ethiopia</option><option value="Falkland Islands">Falkland Islands</option><option value="Faroe Islands">Faroe Islands</option><option value="Fiji">Fiji</option><option value="Finland">Finland</option><option value="France">France</option><option value="French Polynesia">French Polynesia</option><option value="Gabon">Gabon</option><option value="The Gambia">The Gambia</option><option value="Georgia">Georgia</option><option value="Germany">Germany</option><option value="Ghana">Ghana</option><option value="Gibraltar">Gibraltar</option><option value="Greece">Greece</option><option value="Greenland">Greenland</option><option value="Grenada">Grenada</option><option value="Guadeloupe">Guadeloupe</option><option value="Guam">Guam</option><option value="Guatemala">Guatemala</option><option value="Guernsey">Guernsey</option><option value="Guinea">Guinea</option><option value="Guinea-Bissau">Guinea-Bissau</option><option value="Guyana">Guyana</option><option value="Haiti">Haiti</option><option value="Honduras">Honduras</option><option value="Hong Kong">Hong Kong</option><option value="Hungary">Hungary</option><option value="Iceland">Iceland</option><option value="India">India</option><option value="Indonesia">Indonesia</option><option value="Iran">Iran</option><option value="Iraq">Iraq</option><option value="Ireland">Ireland</option><option value="Israel">Israel</option><option value="Italy">Italy</option><option value="Jamaica">Jamaica</option><option value="Japan">Japan</option><option value="Jersey">Jersey</option><option value="Jordan">Jordan</option><option value="Kazakhstan">Kazakhstan</option><option value="Kenya">Kenya</option><option value="Kiribati">Kiribati</option><option value="North Korea">North Korea</option><option value="South Korea">South Korea</option><option value="Kosovo">Kosovo</option><option value="Kuwait">Kuwait</option><option value="Kyrgyzstan">Kyrgyzstan</option><option value="Laos">Laos</option><option value="Latvia">Latvia</option><option value="Lebanon">Lebanon</option><option value="Lesotho">Lesotho</option><option value="Liberia">Liberia</option><option value="Libya">Libya</option><option value="Liechtenstein">Liechtenstein</option><option value="Lithuania">Lithuania</option><option value="Luxembourg">Luxembourg</option><option value="Macau">Macau</option><option value="Macedonia">Macedonia</option><option value="Madagascar">Madagascar</option><option value="Malawi">Malawi</option><option value="Malaysia">Malaysia</option><option value="Maldives">Maldives</option><option value="Mali">Mali</option><option value="Malta">Malta</option><option value="Marshall Islands">Marshall Islands</option><option value="Martinique">Martinique</option><option value="Mauritania">Mauritania</option><option value="Mauritius">Mauritius</option><option value="Mayotte">Mayotte</option><option value="Mexico">Mexico</option><option value="Micronesia">Micronesia</option><option value="Moldova">Moldova</option><option value="Monaco">Monaco</option><option value="Mongolia">Mongolia</option><option value="Montenegro">Montenegro</option><option value="Montserrat">Montserrat</option><option value="Morocco">Morocco</option><option value="Mozambique">Mozambique</option><option value="Myanmar">Myanmar</option><option value="Namibia">Namibia</option><option value="Nauru">Nauru</option><option value="Nepal">Nepal</option><option value="Netherlands">Netherlands</option><option value="New Caledonia">New Caledonia</option><option value="New Zealand">New Zealand</option><option value="Nicaragua">Nicaragua</option><option value="Niger">Niger</option><option value="Nigeria">Nigeria</option><option value="Niue">Niue</option><option value="Norfolk Island">Norfolk Island</option><option value="Northern Mariana">Northern Mariana</option><option value="Norway">Norway</option><option value="Oman">Oman</option><option value="Pakistan">Pakistan</option><option value="Palau">Palau</option><option value="Panama">Panama</option><option value="Papua New Guinea">Papua New Guinea</option><option value="Paraguay">Paraguay</option><option value="Peru">Peru</option><option value="Philippines">Philippines</option><option value="Pitcairn Islands">Pitcairn Islands</option><option value="Poland">Poland</option><option value="Portugal">Portugal</option><option value="Puerto Rico">Puerto Rico</option><option value="Qatar">Qatar</option><option value="Romania">Romania</option><option value="Russia">Russia</option><option value="Rwanda">Rwanda</option><option value="Saint Barthelemy">Saint Barthelemy</option><option value="Saint Helena">Saint Helena</option><option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option><option value="Saint Lucia">Saint Lucia</option><option value="Saint Martin">Saint Martin</option><option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option><option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option><option value="Samoa">Samoa</option><option value="San Marino">San Marino</option><option value="Sao Tome and Principe">Sao Tome and Principe</option><option value="Saudi Arabia">Saudi Arabia</option><option value="Senegal">Senegal</option><option value="Serbia">Serbia</option><option value="Seychelles">Seychelles</option><option value="Sierra Leone">Sierra Leone</option><option value="Singapore">Singapore</option><option value="Slovakia">Slovakia</option><option value="Slovenia">Slovenia</option><option value="Solomon Islands">Solomon Islands</option><option value="Somalia">Somalia</option><option value="Somaliland">Somaliland</option><option value="South Africa">South Africa</option><option value="South Ossetia">South Ossetia</option><option value="Spain">Spain</option><option value="Sri Lanka">Sri Lanka</option><option value="Sudan">Sudan</option><option value="Suriname">Suriname</option><option value="Svalbard">Svalbard</option><option value="Sweden">Sweden</option><option value="Switzerland">Switzerland</option><option value="Syria">Syria</option><option value="Taiwan">Taiwan</option><option value="Tajikistan">Tajikistan</option><option value="Tanzania">Tanzania</option><option value="Thailand">Thailand</option><option value="Timor-Leste">Timor-Leste</option><option value="Togo">Togo</option><option value="Tokelau">Tokelau</option><option value="Tonga">Tonga</option><option value="Trinidad and Tobago">Trinidad and Tobago</option><option value="Tristan da Cunha">Tristan da Cunha</option><option value="Tunisia">Tunisia</option><option value="Turkey">Turkey</option><option value="Turkmenistan">Turkmenistan</option><option value="Turks and Caicos Islands">Turks and Caicos Islands</option><option value="Tuvalu">Tuvalu</option><option value="Uganda">Uganda</option><option value="Ukraine">Ukraine</option><option value="United Arab Emirates">United Arab Emirates</option><option value="United Kingdom">United Kingdom</option><option value="Uruguay">Uruguay</option><option value="Uzbekistan">Uzbekistan</option><option value="Vanuatu">Vanuatu</option><option value="Vatican City">Vatican City</option><option value="Venezuela">Venezuela</option><option value="Vietnam">Vietnam</option><option value="British Virgin Islands">British Virgin Islands</option><option value="US Virgin Islands">US Virgin Islands</option><option value="Wallis and Futuna">Wallis and Futuna</option><option value="Western Sahara">Western Sahara</option><option value="Yemen">Yemen</option><option value="Zambia">Zambia</option><option value="Zimbabwe">Zimbabwe</option><option value="other">Other</option></select>  <label class="form-sub-label" for="input_21_country" id="sublabel_21_country">Country</label></span></td></tr></tbody></table> </div></li><li class="form-line" id="id_130"><div class="form-label-left" id="label_130"><label for="input_130"> Are you interested in volunteer opportunities with The Friendship Circle? </label><label class="label-message" for="input_130"> </label></div><div id="cid_130" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_130_0" name="q130_input130[]" value="Check here" /><label id="label_input_130_0" for="input_130_0"><span>Check here</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_131"><div class="form-label-left" id="label_131"><label for="input_131"> Choose your area/s of interest: </label><label class="label-message" for="input_131"> </label></div><div id="cid_131" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_131_0" name="q131_input131[]" value="Volunteering at programs" /><label id="label_input_131_0" for="input_131_0"><span>Volunteering at programs</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_131_1" name="q131_input131[]" value="Volunteering at Special Events" /><label id="label_input_131_1" for="input_131_1"><span>Volunteering at Special Events</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_131_2" name="q131_input131[]" value="Fundraising" /><label id="label_input_131_2" for="input_131_2"><span>Fundraising</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox-other form-checkbox validate[other]" name="q131_input131[other]" id="other_131" value="" /><span><input type="text" class="form-checkbox-other-input form-textbox form-checkbox validate[other]" name="q131_input131[other][text]" data-otherhint="Other" size="15" id="input_131" disabled="disabled" /></span><br /></span></div> </div></li><li id="cid_40" class="form-input-wide"> <div class="form-header-group"><h2 id="header_40" class="form-header">Help us get to know your child/applicant</h2></div> </li><li class="form-line" id="id_41"><div class="form-label-left" id="label_41"><label for="input_41"> What is your child/the applicant's primary mode of communication<span class="form-required">*</span> </label><label class="label-message" for="input_41"> </label></div><div id="cid_41" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_41_0" name="q41_whatIs41" value="Verbal - Full sentences" /><label id="label_input_41_0" for="input_41_0"><span>Verbal - Full sentences</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_41_1" name="q41_whatIs41" value="Verbal - Words" /><label id="label_input_41_1" for="input_41_1"><span>Verbal - Words</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_41_2" name="q41_whatIs41" value="Hand Gestures" /><label id="label_input_41_2" for="input_41_2"><span>Hand Gestures</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_41_3" name="q41_whatIs41" value="Letter Board" /><label id="label_input_41_3" for="input_41_3"><span>Letter Board</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_41_4" name="q41_whatIs41" value="Picture Board" /><label id="label_input_41_4" for="input_41_4"><span>Picture Board</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio-other form-radio validate[required, other]" name="q41_whatIs41" id="other_41" value="" /><span><input type="text" class="form-radio-other-input form-textbox form-radio validate[required, other]" name="q41_whatIs41[other]" data-otherhint="Other" size="15" id="input_41" disabled="disabled" /></span><br /></span></div> </div></li><li class="form-line" id="id_44"><div class="form-label-left" id="label_44"><label for="input_44"> Are there any specific behaviors your child/the applicant has that we should be aware of?<span class="form-required">*</span> </label><label class="label-message" for="input_44"> </label></div><div id="cid_44" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_44_0" name="q44_areThere" value="Shyness" /><label id="label_input_44_0" for="input_44_0"><span>Shyness</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_44_1" name="q44_areThere" value="Wandering" /><label id="label_input_44_1" for="input_44_1"><span>Wandering</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_44_2" name="q44_areThere" value="Tantrums" /><label id="label_input_44_2" for="input_44_2"><span>Tantrums</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_44_3" name="q44_areThere" value="Hiding" /><label id="label_input_44_3" for="input_44_3"><span>Hiding</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_44_4" name="q44_areThere" value="Hair Pulling" /><label id="label_input_44_4" for="input_44_4"><span>Hair Pulling</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_44_5" name="q44_areThere" value="Aggressiveness" /><label id="label_input_44_5" for="input_44_5"><span>Aggressiveness</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_44_6" name="q44_areThere" value="Biting" /><label id="label_input_44_6" for="input_44_6"><span>Biting</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_44_7" name="q44_areThere" value="None" /><label id="label_input_44_7" for="input_44_7"><span>None</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio-other form-radio validate[required, other]" name="q44_areThere" id="other_44" value="" /><span><input type="text" class="form-radio-other-input form-textbox form-radio validate[required, other]" name="q44_areThere[other]" data-otherhint="Other" size="15" id="input_44" disabled="disabled" /></span><br /></span></div> </div></li><li class="form-line" id="id_127"><div class="form-label-left" id="label_127"><label for="input_127"> If you chose "Other", please provide details: </label><label class="label-message" for="input_127"> </label></div><div id="cid_127" class="form-input"> <textarea id="input_127" class="form-textarea" name="q127_input127" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_72"><div class="form-label-left" id="label_72"><label for="input_72"> Does anything else upset your child/the applicant?<span class="form-required">*</span> </label><label class="label-message" for="input_72"> </label></div><div id="cid_72" class="form-input"> <textarea id="input_72" class="form-textarea validate[required]" name="q72_whatUpsets" cols="40" rows="6"></textarea> </div></li><li id="cid_46" class="form-input-wide"> <div class="form-header-group"><h2 id="header_46" class="form-header">Medical and Emergency Information</h2></div> </li><li class="form-line" id="id_10"><div class="form-label-left" id="label_10"><label for="input_10"> Diagnosis </label><label class="label-message" for="input_10"> </label></div><div id="cid_10" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_10" name="q10_diagnosis" size="20" value="" /> </div></li><li class="form-line" id="id_73"><div class="form-label-left" id="label_73"><label for="input_73"> Any activities your child/ the applicant should not participate in due to limitation or medical condition<span class="form-required">*</span> </label><label class="label-message" for="input_73"> </label></div><div id="cid_73" class="form-input"> <textarea id="input_73" class="form-textarea validate[required]" name="q73_anyActivities" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_48"><div class="form-label-left" id="label_48"><label for="input_48"> Emergency Contact Name<span class="form-required">*</span> </label><label class="label-message" for="input_48"> </label></div><div id="cid_48" class="form-input"> <input type="text" class=" form-textbox validate[required]" data-type="input-textbox" id="input_48" name="q48_emergencyContact" size="20" value="" /> </div></li><li class="form-line" id="id_49"><div class="form-label-left" id="label_49"><label for="input_49"> Emergency Contact Number<span class="form-required">*</span> </label><label class="label-message" for="input_49"> </label></div><div id="cid_49" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><input class="form-textbox validate[required, Numeric]" type="tel" name="q49_emergencyContact49[area]" id="input_49_area" autocomplete="tel-area-code" maxlength="5" size="3" />  <label class="form-sub-label" for="input_49_area" id="sublabel_area">Area Code</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required, Numeric]" type="tel" name="q49_emergencyContact49[phone]" id="input_49_phone" autocomplete="tel-local" size="8" />  <label class="form-sub-label" for="input_49_phone" id="sublabel_phone">Phone Number</label></span></div> </div></li><li class="form-line" id="id_50"><div class="form-label-left" id="label_50"><label for="input_50"> Emergency Contact Cell Number </label><label class="label-message" for="input_50"> </label></div><div id="cid_50" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><input class="form-textbox validate[Numeric]" type="tel" name="q50_emergencyContact50[area]" id="input_50_area" autocomplete="tel-area-code" maxlength="5" size="3" />  <label class="form-sub-label" for="input_50_area" id="sublabel_area">Area Code</label></span><span class="form-sub-label-container"><input class="form-textbox validate[Numeric]" type="tel" name="q50_emergencyContact50[phone]" id="input_50_phone" autocomplete="tel-local" size="8" />  <label class="form-sub-label" for="input_50_phone" id="sublabel_phone">Phone Number</label></span></div> </div></li><li class="form-line" id="id_51"><div class="form-label-left" id="label_51"><label for="input_51"> Relationship to Child/applicant<span class="form-required">*</span> </label><label class="label-message" for="input_51"> </label></div><div id="cid_51" class="form-input"> <input type="text" class=" form-textbox validate[required]" data-type="input-textbox" id="input_51" name="q51_relationshipTo" size="20" value="" /> </div></li><li class="form-line" id="id_74"><div class="form-label-left" id="label_74"><label for="input_74"> Does this person have permission to pick up your child/the applicant?<span class="form-required">*</span> </label><label class="label-message" for="input_74"> </label></div><div id="cid_74" class="form-input"> <div class="form-multiple-column"><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_74_0" name="q74_doesThis" value="Yes" /><label id="label_input_74_0" for="input_74_0"><span>Yes</span></label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_74_1" name="q74_doesThis" value="No" /><label id="label_input_74_1" for="input_74_1"><span>No</span></label></span><span class="clearfix"></span></div> </div></li><li id="cid_133" class="form-input-wide"> <div class="form-header-group"><h2 id="header_133" class="form-header">Media Release Consent</h2></div> </li><li class="form-line" id="id_134"><div id="cid_134" class="form-input-wide"> <div id="text_134" class="form-html"><p>I give permission for the New York Friendship Circle to photograph and/or record video of my child during Friendship Circle programs and events. I understand that these images and videos may be used on the organization’s website, social media platforms, and in print materials to promote the mission and activities of the Friendship Circle. I understand that names of participants are NEVER used.</p>
</div> </div></li><li class="form-line" id="id_135"><div class="form-label-left" id="label_135"><label for="input_135"> Please select one: </label><label class="label-message" for="input_135"> </label></div><div id="cid_135" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_135_0" name="q135_input135" value="Yes, I give permission" /><label id="label_input_135_0" for="input_135_0"><span>Yes, I give permission</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_135_1" name="q135_input135" value="No, I do not give permission (please view our Instagram or Facebook page before choosing this option)" /><label id="label_input_135_1" for="input_135_1"><span>No, I do not give permission (please view our Instagram or Facebook page before choosing this option)</span></label></span><span class="clearfix"></span></div> </div></li><li id="cid_136" class="form-input-wide"> <div class="form-header-group"><h2 id="header_136" class="form-header">Waiver of Liability</h2></div> </li><li class="form-line" id="id_137"><div id="cid_137" class="form-input-wide"> <div id="text_137" class="form-html"><div style="text-align:start"><span style="font-size:small"><span style="color:#222222"><span style="font-family:Arial, Helvetica, sans-serif"><span style="font-style:normal"><span style="font-variant-ligatures:normal"><span style="font-weight:400"><span style="white-space:normal"><span style="background-color:#ffffff"><span style="text-decoration-thickness:initial"><span style="text-decoration-style:initial"><span style="text-decoration-color:initial"><span style="background-color:#ffffff"><font color="#000000"><span style="font-size:14px"><span style="font-family:Arial, &quot;Lucida Grande&quot;, &quot;Lucida Sans Unicode&quot;, &quot;Lucida Sans&quot;, Verdana, Tahoma, sans-serif">I give permission for the participant named above to participate in Friendship Circle events, including but not limited to: bowling, music, art, cooking, hip hop dance, sports, zumba and any other programs sponsored or run by the New York Friendship Circle.</span></span></font></span></span></span></span></span></span></span></span></span></span></span></span><br />
 </div>

<div style="text-align:start"><span style="font-size:small"><span style="color:#222222"><span style="font-family:Arial, Helvetica, sans-serif"><span style="font-style:normal"><span style="font-variant-ligatures:normal"><span style="font-weight:400"><span style="white-space:normal"><span style="background-color:#ffffff"><span style="text-decoration-thickness:initial"><span style="text-decoration-style:initial"><span style="text-decoration-color:initial"><span style="background-color:#ffffff"><font color="#000000"><span style="font-size:14px"><span style="font-family:Arial, &quot;Lucida Grande&quot;, &quot;Lucida Sans Unicode&quot;, &quot;Lucida Sans&quot;, Verdana, Tahoma, sans-serif">I hereby waive and release NY Friendship Circle and The Chai Center, their officers, directors, instructors, volunteers and any affiliates from The Chai Center or other organizations providing services to The Chai Center or the NY Friendship Circle from any claims of liability, including accidents, injury, or loss of personal property while participating in any events hosted or sponsored by the NY Friendship Circle and/or The Chai Center on or off their premises.</span></span></font></span></span></span></span></span></span></span></span></span></span></span></span><br />
 </div>

<div style="text-align:start"><span style="font-size:small"><span style="color:#222222"><span style="font-family:Arial, Helvetica, sans-serif"><span style="font-style:normal"><span style="font-variant-ligatures:normal"><span style="font-weight:400"><span style="white-space:normal"><span style="background-color:#ffffff"><span style="text-decoration-thickness:initial"><span style="text-decoration-style:initial"><span style="text-decoration-color:initial"><span style="font-size:14px"><span style="font-family:Arial, &quot;Lucida Grande&quot;, &quot;Lucida Sans Unicode&quot;, &quot;Lucida Sans&quot;, Verdana, Tahoma, sans-serif"><span style="background-color:#ffffff"><font color="#000000">This acknowledgment of risk and waiver of liability has been read, understood completely, and signed voluntarily by the parent / legal guardian of the participant listed above.</font></span></span></span></span></span></span></span></span></span></span></span></span></span></span></div>
</div> </div></li><li class="form-line" id="id_68"><div class="form-label-left" id="label_68"><label for="input_68"> Signature<span class="form-required">*</span> </label><label class="label-message" for="input_68"> </label></div><div id="cid_68" class="form-input"> <span class="form-sub-label-container"><input type="text" class=" form-textbox validate[required]" data-type="input-textbox" id="input_68" name="q68_signature" size="20" value="" />  <label class="form-sub-label" for="input_68">I understand typing my name here will be considered the same as my legal signature.</label></span> </div></li><li class="form-line" id="id_69"><div class="form-label-left" id="label_69"><label for="input_69"> Date of Application </label><label class="label-message" for="input_69"> </label></div><div id="cid_69" class="form-input"> <div class="datetime-fields"><div class="dir_ltr date-fields"><span class="form-sub-label-container"><input autocomplete="nope" class="form-textbox" id="month_69" name="q69_dateOf[month]" type="tel" size="2" maxlength="2" value="06" />  <label class="form-sub-label" for="month_69" id="sublabel_month">Month</label></span><span class="form-sub-label-container"><input autocomplete="nope" class="form-textbox" id="day_69" name="q69_dateOf[day]" type="tel" size="2" maxlength="2" value="24" />  <label class="form-sub-label" for="day_69" id="sublabel_day">Day</label></span><span class="form-sub-label-container"><input autocomplete="nope" class="form-textbox" id="year_69" name="q69_dateOf[year]" type="tel" size="4" maxlength="4" value="2026" />  <label class="form-sub-label" for="year_69" id="sublabel_year">Year</label></span><span class="form-sub-label-container"><img class="showAutoCalendar" alt="Pick a Date" id="input_69_pick" src="https://w2.chabad.org/images/sitecontrol/formbuilder/calendar.png" align="absmiddle" />  <label class="form-sub-label" for="input_69_pick"><span> </span></label></span></div></div> </div></li><li class="form-line" id="id_121"><div class="form-label-left" id="label_121"><label for="input_121"> How did you hear about The Friendship Circle? </label><label class="label-message" for="input_121"> </label></div><div id="cid_121" class="form-input"> <textarea id="input_121" class="form-textarea" name="q121_input121" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_2"><div id="cid_2" class="form-input-wide"> <div style="text-align: center; text-indent:256px;" class="form-buttons-wrapper button-align-auto"><button id="input_2" type="submit" class="form-submit-button  form-submit-button-none;">Submit</button></div> </div></li><li style="display:none">Should be Empty: <input type="text" name="website" value="" /></li></ul></div><input type="hidden" id="simple_spc" name="simple_spc" value="3065628" /><script type="text/javascript">document.getElementById("si"+"mple"+"_spc").value = "3065628-3065628";</script></form></div>
<div class="center small">
	<img valign="absbottom" src="https://w2.chabad.org/images/global/icons/lock.gif" width="16" height="16" alt="Secure"> This page uses TLS encryption to keep your data secure.
</div>
	<div class="break_floats"></div>
	

<div class="content-footer">
	
	
	
	
	
	
</div>
	</article>

		</div>
	</div>
</div>
						
						<div class="break_floats"></div>
						
					</div>
				</div>
				
				
				

<meta class="js-desktop-local-nav" data-base-class="co_local_menu" />

	<div class="co_local_menu g180 local_content js-local-nav" data-list-name="local navigation">
		
			
				<div class="header ">			
					
						<div class="section_title">
						<div><a data-menu-level="0" data-aid="5717883" href="/templates/articlecco_cdo/aid/5717883/jewish/Participants.htm">Participants</a></div>
						</div>
					
				</div>
				<div class="clearfix body medium_bottom_margin">
					
							
							
								<div class="item selected first" data-menu-level="1">
									<a data-aid="3026556" href="/templates/articlecco_cdo/aid/3026556/jewish/Participant-Registration.htm"><span>Participant Registration</span></a>
									
								</div>
							
						
							
								<div class="item last" data-menu-level="1">
									<a data-aid="5717932" href="/templates/articlecco_cdo/aid/5717919/jewish/Programs.htm" class="link_icon"><span>Programs</span></a>
								</div>
							
							
						<div class="separator"></div>
				</div>
			
			
			
	<div id="LocalNavigationQuickLinks" class="clearfix secondary_navigation local-navigation-quick-links container padding">
		<div class="header small_bottom_padding">
			<div>Quick Links</div>
		</div>

		
				<div class="item ">
					<a href="/article.asp?aid=3761488"><span><span>Contact</span></span></a>
				</div>
			
				<div class="item ">
					<a href="/3514580"><span><span>Donate</span></span></a>
				</div>
			
	</div>

		
	</div>

			</div>
			
			
		</div>
		
		<aside class="page-tools-sidebar js-page-tools-sidebar hide_for_print">
<div class="page-tools js-page-tools-menu">
<div class="page-tools__section page-tools__section--share">
<a class="page-tools__tool js-share-popup page-tools__tool--facebook" data-share-url="https://www.facebook.com/dialog/share?app_id=188669250943&amp;display=popup&amp;href=https%3a%2f%2fwww.nyfriendshipcircle.com%2ftemplates%2farticlecco_cdo%2faid%2f3065628%2fjewish%2f2026-27-Registration.htm%23utm_medium%3dpage_tools%26utm_content%3ddesktop%26utm_source%3dFB">
				<i class="fa fa-facebook"></i>
			</a>
<a class="page-tools__tool js-share-popup page-tools__tool--twitter" data-share-url="https://twitter.com/intent/tweet?text=2026-27+Registration+-+Ariella%27s+NY+Friendship+Circle&amp;url=https%3a%2f%2fwww.nyfriendshipcircle.com%2ftemplates%2farticlecco_cdo%2faid%2f3065628%2fjewish%2f2026-27-Registration.htm%23utm_medium%3dpage_tools%26utm_content%3ddesktop%26utm_source%3dtwitter&amp;via=Chabad">
				<i class="fa fa-twitter"></i>
			</a>
<a class="page-tools__tool js-share-popup page-tools__tool--whatsapp d-lg-none js-share-whatsapp" data-share-url="whatsapp://send?text=2026-27+Registration+-+Ariella%27s+NY+Friendship+Circle https%3a%2f%2fwww.nyfriendshipcircle.com%2ftemplates%2farticlecco_cdo%2faid%2f3065628%2fjewish%2f2026-27-Registration.htm%23utm_medium%3dpage_tools%26utm_content%3ddesktop%26utm_source%3dwhatsapp">
				<i class="fa fa-whatsapp">
					<svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 50 50" fill="#128c7e" width="1em" height="1em"><path d="M25 2C12.318 2 2 12.318 2 25c0 3.96 1.023 7.854 2.963 11.29L2.037 46.73c-.096.343-.003.711.245.966.191.197.451.304.718.304.08 0 .161-.01.24-.029l10.896-2.699C17.463 47.058 21.21 48 25 48c12.682 0 23-10.318 23-23S37.682 2 25 2zm11.57 31.116c-.492 1.362-2.852 2.605-3.986 2.772-1.018.149-2.306.213-3.72-.231-.857-.27-1.957-.628-3.366-1.229-5.923-2.526-9.791-8.415-10.087-8.804-.295-.389-2.411-3.161-2.411-6.03s1.525-4.28 2.067-4.864c.542-.584 1.181-.73 1.575-.73s.787.005 1.132.021c.363.018.85-.137 1.329 1.001.492 1.168 1.673 4.037 1.819 4.33.148.292.246.633.05 1.022s-.294.632-.59.973-.62.76-.886 1.022c-.296.291-.603.606-.259 1.19s1.529 2.493 3.285 4.039c2.255 1.986 4.158 2.602 4.748 2.894.59.292.935.243 1.279-.146.344-.39 1.476-1.703 1.869-2.286s.787-.487 1.329-.292c.542.194 3.445 1.604 4.035 1.896.59.292.984.438 1.132.681.148.242.148 1.41-.344 2.771z"/></svg>
				</i>
			</a>
<a class="page-tools__tool js-share-popup page-tools__tool--pinterest d-none d-lg-block" data-share-url="http://pinterest.com/pin/create/button/?url=https%3a%2f%2fwww.nyfriendshipcircle.com%2ftemplates%2farticlecco_cdo%2faid%2f3065628%2fjewish%2f2026-27-Registration.htm%23utm_medium%3dpage_tools%26utm_content%3ddesktop%26utm_source%3dpinterest&amp;description=2026-27+Registration+-+Ariella%27s+NY+Friendship+Circle">
				<i class="fa fa-pinterest"></i>
			</a>
<a class="page-tools__tool" onclick="showEmailLayer(this);">
<i class="fa fa-envelope"></i>
</a>
</div>
<div class="page-tools__section page-tools__section--other js-page-tool-other">
<div class="page-tools__tool popover-parent d-lg-block">
<div class="popover popover--right align_left nowrap">
<div class="popover__content">
<label class="bold bottom_margin block">
Print Options:
</label>
<form class="vcenter" name="print-form" onsubmit="coPrint(event, 3026556);return false;">
<div>
<label><input type="checkbox" name="print-green"><span title="Save paper and ink">Print without images <i class="fa fa-leaf text-green"></i></span></label>
</div>
<br/>
<div class="center">
<button class="co-button page-tools__print-button">Print</button>
</div>
</form>
</div>
</div>
<i class="fa fa-print"></i>
</div>
</div>
</div>
<div class="js-fab-wrapper fab-wrapper">
<div class="fab">
<i class="fab-icon"></i>
</div>
</div>
</aside>
<!-- END CACHE -->
	</div>

				<div class="break_floats"></div>
			</div>
		</div>
		<div id="bot2" class="clearfix">
			<div class="main">	
				<div class="block-aboutsite g320">
					<div class="block-title">Ariella's NY Friendship Circle</div>
					<div class="block-content">
						501 Vanderbilt Parkway <br />Dix Hills, NY 11746<br />631-351-8672			
					</div>
				</div>
				
						<div class="block-aboutus g320">
							<div class="block-title">About Us</div>
							<div class="block-content">
								<ul> 
					
						<li>
							<a href="/article.asp?aid=4118351">Home</a>
						</li>
					
						<li>
							<a href="/article.asp?aid=6773038">The Weekly Update</a>
						</li>
					
						<li>
							<a href="/article.asp?aid=3007051">Parent Feedback</a>
						</li>
					
						<li>
							<a href="/article.asp?aid=7446656">Resources</a>
						</li>
					
						<li>
							<a href="/article.asp?aid=3761488">Contact</a>
						</li>
					
								</ul>
							</div>
						</div>
					
						<div class="block-aboutus g320">
							<div class="block-title">Participants</div>
							<div class="block-content">
								<ul> 
					
						<li>
							<a href="/article.asp?aid=3026556">Participant Registration</a>
						</li>
					
						<li>
							<a href="/article.asp?aid=5717932">Programs</a>
						</li>
					
								</ul>
							</div>
						</div>
						
				<div class="block-aboutus g320" style="display:none">
					<div class="block-title">About Us</div>
					<div class="block-content">
						<ul> 
							<li><a href="#">Weinberg Village</a></li>
							<li><a href="#">FC International</a></li>
							<li><a href="#">Our Staff</a></li>
							<li><a href="#">Contact Us</a></li>
							<li><a href="#">News</a></li>
							<li><a href="#">Calendar</a></li>
						</ul>
					</div>
				</div>	
				<div class="block-get-involved g320" style="display:none">
					<div class="block-title">Get Involved</div>
					<div class="block-content">
						<ul> 
							<li><a href="#">Families</a></li>
							<li><a href="#">Volunteers</a></li>
							<li><a href="#">Schools</a></li>
							<li><a href="#">Donate</a></li>
							<li><a href="#">Corporate Friend</a></li>
						</ul>
					</div>
				</div>
			</div>
		</div>
	</div>

	

	<div id="footer" class="clearfix">
		<div class="main">
			<div class="g960">
			Copyright © 2026 Friendship Circle
			



	<div class="footer3">
		<span class="footer-title" >Ariella's NY Friendship Circle</span>
		<div class="footer-address">
			<span class="footer-street">501 Vanderbilt Parkway </span>
			<span class="footer-city-state">Dix Hills, NY 11746</span>
		</div>
			<span>631-351-8672</span>
	</div>
	<img src="https://w2.chabad.org/images/global/spacer.gif" width="1" height="6" border="0" /><br />



Powered by <a href="https://www.chabad.org/" target="_new" class="">Chabad.org</a> &copy; 1993-2026 <a href="/4026210" target="_blank" class="privacy-link">Privacy Policy</a>




			</div>
		</div>
	</div>

	
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/os/jquery-latest.min.js?v=278824AF"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/os/jquery/jquery-noconflict.js?v=32FA5B68"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/os/jquery/jquery.inputmask.min.js?v=BF33D3B4"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/co/dist/CoLib.js?v=CC07618E"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/WebComponents/bundles/magen-cdo-global.js?v=5457FBE7"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/modules/pagetools.js?v=930B07AB"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/custom/multimedia/infolayer.js?v=ED1B8531"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/templates/forms/userform.js?v=E69144BF"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/article/comments/reply-form-controller.js?v=DC70C970"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/custom/commentsloader.js?v=AD6AAB79"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/custom/subscribeprompt.js?v=86D84DC2"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/templates/FormDecoder.js?v=83AF6F1A"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/custom/deprecated.js?v=D506A83E"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/OverrideJSDocumentWrite.js?v=9A0227AA"></script><script>$j = $j.fn ? $j : jQuery;$j(()=>{$q.forEach(f=>{try{f.call(window);}catch(ex){console.error(ex);}});})</script>
	

<script  language="javascript" type="text/javascript"> Co.Settings      = {CacheClassName:'js-cache-default',MosadName:'Ariella\'s NY Friendship Circle'}; Co.ArticleId     = '3065628';Co.SectionId     = 5717883;Co.PartnerSiteId = 0;Co.SiteId        = 9841;Co.IsMobilePage  = false;Co.IsResponsive  = false;Co.DbDomain      = 'NYFriendshipcircle.com';Co.LanguageCode  = '';Co.LoginStatus   = 'None';</script>
</body>
</html>