Volunteer Information

First Name:

Last Name:

Date of Birth:





Home Phone Number:

Cell Phone:

Email Address:

School Attending:


Are you Jewish?:
Father's Name: 
Father's Email Address: 
Father's Cell Phone: 
Mother's Name: 
Mother's Email Address: 
Mother's Cell Phone: 
Parents Marital Status: 


Friends @ Home Preferences:

What's your day of week/time preference? (First Choice)

What's your day of week/time preference (Second Choice)

Would you be willing to drive out of your home town?  Yes  No
Do you have a friend you'd like to volunteer with?  Yes  No
Friend's Name
Friend's Phone Number


Additional Information

Which program are you interested in:

Have you volunteered before? Where?:

Why would you like to volunteer: 

How did you find out about us?

Additional Comments:

Parental Consent: I give my teen permission to volunteer in the Friendship Circle:  Yes  No
I permit my child's photos to be used for publicity purposes:  Yes  No
Today's Date:   
Signature of Parent/Guardian: