Young Adult Registration Form

Was the 'Adult Emergency Registration Form' filled out for this participant already? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{ binding displayValue, mode=oneTime }

Please fill out the emergency registration from prior to registering for a program.

please click here to go to the form

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Nickname {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

YAD Men - First & Third Sunday of the month - 4:45-5:45 pm {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{{ ['Full Year - $200.00','Per Session - Pay at door. please contact program administrator - $15.00'][$index] }}

Times may vary depending on activity.

YAD Women - First & Third Monday of the month - 6:00-7:30 pm {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{{ ['Enrollment Fee - Full Year - $200.00','Per Session - Pay at door. please contact program administrator - $15.00'][$index] }}

Times may vary depending on activity.

Discount Code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Please Contact Rena at (216) 377-3000 or Email Rena@friendscleveland.com for coupon code

Payment Options {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{ binding displayValue, mode=oneTime }

Organization Funding Waiver Information

Organization Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Case Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Contact Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Contact Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Check/Cash - Please print this form after subbmitting and mail or bring in with payments to the Friendship Circle.

Discount Code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Please Contact Rena at (216) 377-3000 or Email Rena@friendscleveland.com for coupon code

Please send my invoice to {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{ binding displayValue, mode=oneTime }

Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{~ Payment_Block_Label}

{binding Group}
{binding Name} - {binding Description}	{binding displayValue}
{{ Cognito.resources['payment-subtotal'] + ":" }}	{binding displayValue}
{binding Name}:	{binding displayValue}	---

{{ Cognito.resources['payment-amount-due'] + ":" }} {binding displayValue}

Young Adult Registration Form

{{ Cognito.resources['order-number-label'] }}: {binding displayValue}

{{ Cognito.resources['order-date-label'] }}: {binding displayValue}

{{ Cognito.resources['order-method-label'] }}: {binding MethodReference}

{binding BillingName}

{binding PhoneNumber}

{binding EmailAddress}

{binding Group}
{binding Name} - {binding Description}	{binding displayValue}
{{ Cognito.resources['payment-subtotal'] + ":" }}	{binding displayValue}
{{ Cognito.resources['order-total-label'] }}: {binding displayValue}
{{ Cognito.resources['order-amount-paid'] }}:	({binding displayValue})
{{ Cognito.resources['order-balance-due-label'] }}:	{binding displayValue}

Was the 'Adult Emergency Registration Form' filled out for this participant already? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Please fill out the emergency registration from prior to registering for a program.

please click here to go to the form

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Nickname {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

YAD Men - First & Third Sunday of the month - 4:45-5:45 pm {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{{ ['Full Year - $200.00','Per Session - Pay at door. please contact program administrator - $15.00'][$index] }}

YAD Women - First & Third Monday of the month - 6:00-7:30 pm {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{{ ['Enrollment Fee - Full Year - $200.00','Per Session - Pay at door. please contact program administrator - $15.00'][$index] }}

Discount Code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Payment Options {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Organization Funding Waiver Information

Organization Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Case Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Contact Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Contact Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Check/Cash - Please print this form after subbmitting and mail or bring in with payments to the Friendship Circle.

Discount Code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Please send my invoice to {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Young Adult Registration Form

{{ Cognito.resources['order-number-label'] }}: {binding displayValue}

{{ Cognito.resources['order-date-label'] }}: {binding displayValue}

{{ Cognito.resources['order-method-label'] }}: {binding MethodReference}

{binding BillingName}

{binding PhoneNumber}

{binding EmailAddress}

{binding Group}
{binding Name} - {binding Description}	{binding displayValue}
{{ Cognito.resources['payment-subtotal'] + ":" }}	{binding displayValue}
{{ Cognito.resources['order-total-label'] }}: {binding displayValue}
{{ Cognito.resources['order-amount-paid'] }}:	({binding displayValue})
{{ Cognito.resources['order-balance-due-label'] }}:	{binding displayValue}

Was the 'Adult Emergency Registration Form' filled out for this participant already? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Please fill out the emergency registration from prior to registering for a program.

please click here to go to the form

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Nickname {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

YAD Men - First & Third Sunday of the month - 4:45-5:45 pm {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{{ ['Full Year - $200.00','Per Session - Pay at door. please contact program administrator - $15.00'][$index] }}

YAD Women - First & Third Monday of the month - 6:00-7:30 pm {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{{ ['Enrollment Fee - Full Year - $200.00','Per Session - Pay at door. please contact program administrator - $15.00'][$index] }}

Discount Code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Payment Options {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Organization Funding Waiver Information

Organization Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Case Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Contact Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Contact Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Check/Cash - Please print this form after subbmitting and mail or bring in with payments to the Friendship Circle.

Discount Code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Please send my invoice to {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Young Adult Registration Form

Please fill out the emergency registration from prior to registering for a program.

please click here to go to the form

Organization Funding Waiver Information

{~ Payment_Block_Label}

Young Adult Registration Form

{{ Cognito.resources['order-transaction-details-header'] }}

{{ Cognito.resources['order-billing-info-header'] }}

Please fill out the emergency registration from prior to registering for a program.

please click here to go to the form

Organization Funding Waiver Information

Young Adult Registration Form

{{ Cognito.resources['order-transaction-details-header'] }}

{{ Cognito.resources['order-billing-info-header'] }}

Please fill out the emergency registration from prior to registering for a program.

please click here to go to the form

Organization Funding Waiver Information