Friendship Circle Volunteer Form

Full Name*

First NameLast Name

Birth Date*

MonthDayYear

Cellphone*

Area CodePhone Number

Address*

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

E-mail*

School*

Grade*

Mom's Email*

Mom's Cell*

Area CodePhone Number

Parent's Names

Dad Cell Phone*

Area CodePhone Number

I am interested in...*

[email protected]Family Holiday Programs

Are your parents able to drive you to or from a child’s home?*

YesNo

When would you like to volunteer at a special needs child’s home?

First Choice

Day of the week*

Time*

Second Choice

Day of the week*

Time*

I would like to work with a child who is*

1-5 years5-10 years10 & up

Do you have a friend that you would like to volunteer with?*

YesNo

Their Name

First NameLast Name

Their Phone Number

Area CodePhone Number

Please list two references (not a relative)

Reference 1

Full Name*

First NameLast Name

Relationship*

Phone Number*

Area CodePhone Number

Reference 2

Full Name*

First NameLast Name

Relationship*

Phone Number*

Area CodePhone Number

Have you had past experience working with children?*

YesNo

If yes please specify

Give a brief explanation of why you are interested in volunteering in the Friendship Circle

Emergency Contact Information:

Full Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Relationship*

I permit my child’s photo to be used for publicity purposes*

YesNo

Signature of Parent*

Date*

MonthDayYear

Volunteer Signature*

Date*

MonthDayYear

Friends Helping Friends - Friends at Home

PARENTAL CONSENT

Toddlers

Youth

Teens

Adults

Friendship Circle

Upcoming