Friendship Circle Registration

Friendship Circle Registration

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  • Your Child

  • Parents

  • Siblings

  • Friends @ Home

  • What day of the week would you like the volunteers to come visit at your home?

  • What time of the day would you like the volunteers to come visit at your home?

  • If yes:

  • For Past Members of Friendship Circle ONLY

  • Please list the volunteers who visited with your child last year:
  • Additional Information

  • Additional Friendship Circle Programs

  • Medical Information

  • Emergency Contact (other than parent):
  • Respite Service Agreement-Required

  • It is the Friendship Circle's pleasure to provide its services. However, it is necessary for the parents/guardians to assume responsibility to oversee activities shared together.
    By signing below, I agree to ensure that a parent/guardian will be home while volunteers are interacting with my child.
    I also agree to release the Friendship Circle, its providers and administrators from all liability from and incident which affects the health, welfare or safety of my child in the provision of such service.
  • Should be Empty:
 Email
The Friendship Circle of Passaic County
194 Ratzer Road
Wayne, NJ 07470-5441
973-694-6274