Volunteer Sign Up Form

Basic Volunteer Info:

Full Name*

First Name Last Name

Birth Day*

Month Day Year

Address*

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

Cell Phone Number*

Area Code Phone Number

E-mail*

School Attending*

Grade*

Year Graduating*

Are you Jewish?*

YesNo

Parent Info:

Father Name*

First Name Last Name

Father Cell*

Area Code Phone Number

Father Email*

Mother Name*

First Name Last Name

Mother Cell*

Area Code Phone Number

Mother Email*

Parent Marital Status*

Additional Volunteer Information:

Interested in:*

Have you volunteered before? Where?

Why would you like to volunteer?*

How did you find out about us?*

Additional Comments:

Friends At Home Preferences (if applicable):

(First choice) Day of week/time preference:

(Second choice) Day of week/time preference:

Do you have a friend you'd like to volunteer with?

YesNo

Name of Friend:

Personal References:

Reference #1:*

First Name Last Name

Relationship to reference:

Phone Number:*

Area Code Phone Number

Reference #2:*

First Name Last Name

Relationship to reference:

Phone Number:*

Area Code Phone Number

Parental Consent:

I give my child permission to volunteer with The Friendship Circle:*

YesNo

I permit my child's photos to be used for publicity purposes:*

YesNo

Today's Date

Month Day Year

Parent Signature*

Select to proceed to Part 2*

I'm ready to continue!

Full Name*

First Name Last Name

E-mail*

I will promote the creation of a friendship community based on mutual respect and a sense of personal well-being. I will treat others with honor and respect because we are all created in the image of G-d.

As a volunteer of Friendship Circle:

∗ I understand that Friendship Circle expects me to behave responsibly. I agree to utilize my best judgment and sense of responsibility when spending time with the child with whom I am matched.

∗ I understand that the use of a cell phone during a Friendship Circle programs does not promote a healthy friendship and should only be used in case of emergency.

∗ I agree to respect the privacy of all participants of the Friendship Circle and to keep personal information confidential.

∗ I understand that once I commit to attend a program or event, the Friendship Circle staff and special friends expect me to be there. I agree to attend and give it my best effort. In the event that I cannot attend, I agree to give notice to Friendship Circle staff and the parents of my special friend sufficiently in advance.

∗ If someone gets hurt or some other incident occurs while I am volunteering, it is my responsibility to immediately report the occurrence to Friendship Circle staff.

∗ I agree to represent the Friendship Circle to the best of my abilities.

∗ I have carefully read and agree to abide and be bound by all additional rules and policies in the Friendship Circle Handbooks and any additional rules pertinent to specific events, including the Commitment to Everyone’s Safety and Well Being.

∗ I grant Friendship Circle permission to use my name, image, likeness, or recording in connection with any promotional materials including, but not limited to, brochures, advertising, and broadcasts.

Your Initials:*

I agree to volunteer for Friendship Circle.

I understand that participation in Friendship Circle activities involves a certain degree of risk and can be physically, mentally, and emotionally demanding. I have carefully considered the risk involved and agree to participate in this activity.

I also understand that participation in this activity is entirely voluntary and requires participants to abide by applicable rules and standards of conduct as set forth in the Friendship Circle Handbook, as it may be modified from time to time.

I understand that this local Friendship Circle is independently owned, operated and controlled. I release the Friendship Circle and its employees, directors, officers, and volunteers as well as its affiliates and all other organizations associated with Friendship Circle from any and all claims or liability arising out of this participation.

My son/daughter has my permission to attend Friendship Circle events. I agree not to hold Friendship Circle liable for any accident, loss or theft that may occur during the course of an event. I hereby give my permission to the physician selected by the Friendship Circle to hospitalize, and/or secure necessary treatment or anesthesia for my child, as named above, in the event that I cannot be reached in an emergency. I hereby give my permission that paramedics may transport my child to the nearest hospital, if necessary. I have indicated any pertinent medical information above. I agree to the terms and conditions of this application.

Comments (optional):

Volunteer's Signature*

If the volunteer is under the age of 18, the signature of a parent or guardian signature is necessary, please sign below:

Full Name of Parent/Guardian*

First Name Last Name

Parent/Gaurdian's Signature*

Date*

Month Day Year

Volunteer Code of Conduct

Medical & Emergency Release