Volunteer InformationFull NameFirst NameLast NameE-mailBirth Date1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearAddressStreet AddressStreet Address Line 2CityState / ProvincePostal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOtherCountryHome NumberArea CodePhone NumberCell NumberArea CodePhone NumberSchoolGrade (2022-2023 school year)Parent/GuardianFirst NameLast NameCellArea CodePhone NumberEmailParent/GuardianFirst NameLast NameCellArea CodePhone NumberEmailFriends @ Home (Skip this section if you are signing up for programs only)What day of the week are you available to volunteer for Friends @ Home Visitations?First Choice (please include day of week and time of day)Second Choice (please include day of week and time of day)Do you have a friend with whom you'd like to volunteer?YesNoYour friend's nameFirst NameLast NameYour friends numberArea CodePhone NumberIs your friend currently registered as a volunteer with the Friendship Circle?YesNoAre your parents available to drive you to and from the child's home?YesNoPlease list one reference (may not be a relative):Reference's relationship to youReference's phone numberArea CodePhone NumberReference's emailVolunteers from Previous Years ONLYWho 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:Additional Friendship Circle ProgramsThe 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.Programs I am interested in: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)MailingsSetting up for Volunteer TrainingsOtherMedical InformationEmergency Contact (other than parent)Phone NumberArea CodePhone NumberPlease list any allergies or medical conditions we should be aware of:Parental Consent-RequiredI give my teen permission to volunteer with the Friendship CircleYesI permit the Friendship Circle to use my teen's photo for publicity purposesYesNoI would like to assist as a volunteer at Friendship Circle programsYesNoParent's Signature:Date:Volunteer Consent-RequiredI agree to:Keep all information confidentialSubmit a weekly report of my Friends @ Home visit (includes time spent and summary of visit)Notify the office and my special friend ASAP in the even that I am unable to visit and I will try to find a substituteSignatureDateQuestions? Comments? Suggestions? Let us know!SubmitShould be Empty: This page uses TLS encryption to keep your data secure.