Become a Member

Registration Date*

HFC Member's Name*

Birthdate*

How did you hear about HFC?

If Other, please specify

Address*

City*

State*

Zip Code*

Member's Phone Number (Home)*

Member's Phone Number (Cell)

Member's Email Address*

Parent Information

Parent/Guardian #1 Information

Parent 1 Name*

Parent Address*

Home Phone Number*

Mobile Phone Number

Email Address*

Parent/Guardian #2 Information (if different that Member's information)

Parent 2 Name

Address

Home Phone Number (if different)

Mobile Phone Number

Email Address

Emergency Name/Phone Number*

Disability*

Special diet needs/Allergies*

Special Information, please be thorough, this information could be crucial to your child’s safety (seizures, behaviors ect…)*

General Information about the participant’s abilities/need for assistance*

I give permission for the participant to be photographed and for the photo(s) to used with HFC print materials, HFC Video, HFC slideshows, and the HFC website.

Yes

Yes, but do not use name with photo

Please download, fill out, & mail in this REQUIRED Highland Friendship Club waiver form.

Check here if you do not want to receive a hard copy of the newsletter form.
I do not need a mailing for the newsletter. I am able to print from the HFC website or weekly email.

News

May 18
2012

Bingo Night!

View Event

May 19
2012

Fitness Class

View Event

May 19
2012

Choir

View Event