Name

Address

City

Home Phone

Cell Phone

Email

Grade

School

Zip

Birthday

Apt.

State

Mom’s Name:                                               Mom’s Email:                               Mom’s Cell:

Dad’s Name:                                         Dad’s Email:                                  Dad’s Cell:

When would you like to volunteer at the home of a child with special needs?

FIRST CHOICE:

SECOND CHOICE:

Day of the Week

Do you have a friend with whom you would like to volunteer?

Phone Number

Your Friend's Name

Time

Please list one reference, who is not a relative. (For new FC Volunteers only).

Day of the Week

Time

Name

Relationship

Phone

I give my teen permission to volunteer in the Friendship Circle

I give permission for my teen's photo/s to be used for publicity purposes

Parent's Name

I (Parent of the Volunteer), would be interested in assisting the Friendship Circle in future events

PARENTAL CONSENT

Date

Thank you for applying to be a Friendship Circle volunteer!

Just submit this form and we will contact you as soon as possible.

Thank you!

VOLUNTEER INFORMATION

Are you Jewish?

What age child would you prefer working with?

Would you prefer working with a boy/girl?

How did you hear about the Friendship Circle?

Have you been part of the Friendship Circle in the past?

Do you have a Facebook account? If yes, how can you be found?

Are you interested in joining the Friendship Circle Leadership Club?

(For 11th & 12th graders only)

Yes

No

Yes

No

Yes

No

YesNo