Name *

First Name

Last Name

Birth Date *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Principals Name *

First Name

Last Name

Name of Reference *

Please provide a non family relation

First Name

Last Name

Phone # of Reference *

(###)

###

####

Father's Name *

First Name

Last Name

Mother's Name *

First Name

Last Name

Check all the days you are available to volunteer:

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Any days you can not volunteer:

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

I would like to volunteer with my friend

First Name

Last Name

Please select your first choice of time that works for a visit:

Hour

Minute

Second

AM PM

Please select your 2nd choice of time that works for a visit:

Hour

Minute

Second

AM PM

Bowling Buddies

8/4

9/1

10/6

11/3

12/1

1/5

2/2

3/16

4/6

5/4

6/1

Shabbat Dinner

8/30

11/8

12/6

1/24

3/7

5/2

Holiday

10/20 Sukkot Party

3/14 Purim Party

6/2 Shavous Ice Cream Party

Tennis

9/29

10/27

11/24

12/15

1/26

2/23

3/23

4/27

5/25

6/15

Winter Camp

12/23

12/24

12/25

12/26

How would you prefer to be contacted ?

Email

Phone

Facebook

Text Message

Emergency contact name (other than parent)

First Name

Last Name

*

There will be an orientation seminar in September 8, which all new volunteers will be required to attend before beginning to volunteer. This seminar will prepare the volunteer to work with a child with disabilities. At this time volunteers can address any concerns and can then choose the program that is a good fit for them.

Any information pertaining to the child or family will be confidential.

Community service forms will ONLY be issued for volunteering that is recorded on the FC Connect app.

When you commit to being a volunteer, we will be relying on you as a buddy for one of the children.

In the event that you are unable to volunteer, you will need to notify the Friendship Circle at least 3 days in advance and will try to find a substitute.

By checking this box you are aware and agree to all of the above.

Signature *

First Name

Last Name

Date *

MM

DD

YYYY