Vol unteer Registration Form

Volunteer Information

Name (First, Last)

DOB (mm/dd/yyyy) //

Address

City

State

Zip

Home # Cell #

Email

School Grade (2015-2016)

Additional Information

Mother's Name Cell #

Father's Name Cell #

FRIENDS @ HOME (skip if you're signing up for Programs Only)

What day of the week are you available to volunteer for Friends @ Home Visitations?

First Choice: Time

Second Choice Time

Do you have a friend with whom you'd like to volunteer? Yes No

Your Friend's Name Phone #

Is your friend currently registered as a volunteer with the Friendship Circle? Yes No

Are your parents available to drive you to/from the child's home? Yes No

Please list one reference (may not be a relative):

Reference's Name Relationship

Phone # Email

Please see the attached form, "Volunteer Reference Form", for your reference to fill out.

Volunteers from Previous Years ONLY

Who was your special friend last year?

If you visited with another volunteer, please specify:

Were you happy with last year's arrangement? Would you like to volunteer with a different child? With a different volunteer? Please elaborate below.

Additional Friendship Circle Programs

The Friendship Circle includes many additional programs in addition to Friends @ Home. Assistance is greatly needed and very necessary to ensure the success of these programs. These events are scattered over the course of the year and though you may not be available to assist at each one, we would greatly appreciate if you were open to volunteering.

Please indicate the programs of interest. We will notify you when such programs are scheduled. Should you be available to assist as a volunteer please respond as such.

Holiday Events (Chanukah Celebration, Purim Party, Model Matzah Bakery, Lag BaOmer Festival)

Sports League (Monthly Sessions)

Birthday Club (Volunteers on this committee will help plan exciting birthday visits for children included in the program)

Chai-a-Thon (Fundraising initiative through calling members of the community to take place on a designated Sunday)

Mailings

Setting up for Volunteer Trainings

Other

Medical Information

Emergency Contact (other than parent)

Name Phone #

Please list any allergies or medical conditions we should be aware of:

Parental Consent-Required

I give my teen permission to volunteer with the Friendship Circle

I permit the Friendship Circle to use my teen's photo for publicity purposes Yes No

I would like to assist as a volunteer at Friendship Circle programs Yes No

Signature of Parent Date

Volunteer Consent-Required

I agree to keep all information confidential

In the event that I am unable to volunteer I will notify the office and and my special friend ASAP and will try to find a substitute.

I agree to submit a weekly report of my Friends @ Home visit (includes time spent and summary of visit)

Signature of Volunteer Date

Questions? Comments? Suggestions? Let us know!