Returning Family 2021 – 2022 Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *PhoneAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeAre there any updates to your medical or emergency contact information? *YesNoMedical Information UpdateInsurance Information UpdateEmergancy Contact UpdatePlease list any allergies or medical conditions we should be aware of: *Health Insurance Provider: *Policy Number: *Emergancy Contact Name *FirstLastRelation to child? *Phone Number *Doctors Name *FirstLastPhone Number *Program Registration Friends@Home. Ages 4-17Through the weekly visits, the pair establish a warm friendship that combats the loneliness and isolation so often felt by individuals with special needs. At the same time, their teen volunteers learn the priceless value of giving.Background CheckOur insurance requires that anyone who interacts with minors needs to be screened. That said, both parents and adults in the house, while a Friendship House visit is taking place, need to complete a background check. We have partnered with Sterling Volunteers to complete this process securely. The Friendship House will never see your personal information or background information and will only receive a report verifying your ability to care for minors. If you sign up for our Friends@Home program, In your welcome email, you will be provided with our unique Friendship House code to use when entering your information.I would like my child to join Friends@Home: *YesNoPlease provide your first choice of time for the Friends@Home visit. *DaySundayMondayTuesdayWednesdayThursdayFridaySaturdayFriends@Home is a one-hour program.Please provide your second choice of time for the Friends@Home visit. *DaySundayMondayTuesdayWednesdayThursdayFridaySaturdayFriends@Home is a one-hour program.CommentsSunday Circle. Ages 4 +Sunday Circle offers a wonderful opportunity for children to gain from group activities while still receiving one-on-one attention from their volunteers. Activities include sports instruction, music and movement instruction, arts and crafts. Sunday Circle is a two-hour drop off program, creating an excellent respite opportunity for parents. Sunday Circle occurs up to twice a month from 2:00 - 4:00 pm from October through May. Volunteers will be paired up with their special friend Dates Coming SoonI would like my child to join Sunday Circle: *YesNoYoung Adults Club. Ages 18+Young adults with special needs enjoy a monthly program (Tuesdays 6:00 - 7:30) aimed at facilitating socialization with peers and young adult volunteers. The goal of this program is to give young adults with special needs the opportunity to make friends and hang out outside of the home in a fun, safe, and relaxed environment. We have organized activities for everyone to participate in that will help build confidence, social skills, and life skills… all while building memories and fostering friendships that will last years!Dates Coming SoonI would like my child to join Young Adults Club: *YesNo Please provide feedback on your experience at Friendship House and any recommendations for the coming year? *I’d love to contribute with: (List any talents/ methods you can help)EmailSubmit