Volunteer Registration

Full Name

First NameLast Name

E-mail

Birth Date

MonthDayYear

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Number

Area CodePhone Number

Cell Number

Area CodePhone Number

School

Grade (2018/2019 school year)

Mother's Name

First NameLast Name

Mother's Cell

Area CodePhone Number

Father's Name

First NameLast Name

Father's Cell

Area CodePhone Number

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?

YesNo

Your friend's name

First NameLast Name

Your friends number

Area CodePhone Number

Is your friend currently registered as a volunteer with the Friendship Circle?

YesNo

Are your parents available to drive you to and from the child's home?

YesNo

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

Reference's relationship to you

Reference's phone number

Area CodePhone Number

Reference's email

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:

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.

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 TrainingsOther

Emergency Contact (other than parent)

Phone Number

Area CodePhone Number

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

I give my teen permission to volunteer with the Friendship Circle

Yes

I permit the Friendship Circle to use my teen's photo for publicity purposes

YesNo

I would like to assist as a volunteer at Friendship Circle programs

YesNo

Parent's Signature:

Date:

I 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 substitute

Signature

Date

Questions? Comments? Suggestions? Let us know!

Volunteer Information

Friends @ Home (Skip this section if you are signing up for programs only)

Volunteers from Previous Years ONLY

Additional Friendship Circle Programs

Medical Information

Parental Consent-Required

Volunteer Consent-Required