Volunteer

First Name *

Middle Name

Last Name *

Birth Date *

To calculate Jewish Birthday

Birth Date Before Sunset

Yes

No

Unknown

Hebrew Name

Example: David or דוד

Street Address *

City *

State *

Zip *

Country *

Preferred Communication Method *

Call Text Email Facebook Instagram

School *

Graduating Year *

Synagogue

Fill in if you belong to a Synagogue - otherwise write N/A

Email *

Cell Phone *

Home Phone *

Parent One

First Name *

Last Name *

Email *

Cell Phone *

Please complete address info if different than above

Street Address

City

State

Zip

Parent Two

First Name

Last Name

Email

Cell Phone

Please complete address info if different than above

Street Address

City

State

Zip

How did you hear about Friendship Circle? *

Would you like to participate in the Friends at Home program? *

Yes No

Is there a teen volunteer you would like to participate with in the Friends at Home program? *

Yes No

Name of Teen Volunteer

Please list any activities you will not be able to participate in due to a limitation or medical condition, or any additional concerns or information our staff should be aware of in order to ensure your safety.

Please provide two references along with their emails. Must be an individual over 18 years of age, i.e. Rabbi, Teacher or Employee and NOT IMMEDIATE FAMILY.

Reference One Name *

Reference One Email *

Reference Two Name *

Reference Two Email *

In case of an emergency please contact:

Emergency Contact Name *

Emergency Contact Cell Phone *

Emergency Contact Relationship *

Volunteer Agreement

In the event I am unable to attend regularly scheduled Friends at home I will find an alternative way to connect with my partner *

Yes

I will log my hours after I volunteer. *

Yes

In the event of a volunteer function I will try my hardest to attend– however, regardless, I will always respond. *

Yes

Parental Consent

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. *

Yes No

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

Yes No