Young Adult Registration Form

Was the 'Adult Emergency Registration Form' filled out for this participant already? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
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 firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
YAD Men - First & Third Sunday of the month - 4:45-5:45 pm {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

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 }
{ binding firstError.message }

Times may vary depending on activity.

YesNo NoYes
{ 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 firstError.message }

Organization Funding Waiver Information

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

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

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

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

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

{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}
{ binding firstError.message }
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}
{ binding firstError.message }
Nickname {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
YAD Men - First & Third Sunday of the month - 4:45-5:45 pm {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
YAD Women - First & Third Monday of the month - 6:00-7:30 pm {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Discount Code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Payment Options {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Organization Funding Waiver Information

Organization Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Case Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Contact Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Contact Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ 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 }
{binding displayValue}
{ binding firstError.message }
Please send my invoice to {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Young Adult Registration Form

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

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

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

{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}
{ binding firstError.message }
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}
{ binding firstError.message }
Nickname {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
YAD Men - First & Third Sunday of the month - 4:45-5:45 pm {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
YAD Women - First & Third Monday of the month - 6:00-7:30 pm {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Discount Code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Payment Options {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Organization Funding Waiver Information

Organization Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Case Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Contact Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Contact Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ 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 }
{binding displayValue}
{ binding firstError.message }
Please send my invoice to {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }