1Volunteer Information

2About Me

3Parent/Guardian Information

4Program Registration

5Medical & Emergency Information

6Consent

Name *

First

Last

Gender *

Male
Female

Date of Birth *//

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone

Cell Phone Number *

Email *

Which school do you attend? *

Grade *

8th Grade
Freshman
Sophomore
Junior
Senior

Religion? *

Are you affiliated with any Temple? *

Please note which Temple you are affiliated with.

Best method of contact: *

Text
Email
Phone

References

Please list 2 non-family references:

Name 1 *

First

Last

Phone Number *

Connection: *

Name 2

First

Last

Phone Number

Connection:

Why are you interested in participating in Friendship House?

What does friendship mean to you? What does inclusion mean to you?

What do you hope to get out of your experience at Friendship House? What are your expectations?

Please tell us more about your personality. For example, What is your greatest strength or talent? What are your strongest character traits?

What do you enjoy doing the most?

Are you interested in a leadership position? (Only available for Juniors and Seniors)

The leadership position will allow you to impact our community on a greater scale and includes the following requirements; recruiting other volunteers at your school, creating exclusive volunteer events, promoting Friendship House in your community and on social media.

Are you over 18? *

Parent Information

Mother's Name *

First

Last

Mother's Cell *

Mother's Email *

Occupation:

Father's Name *

First

Last

Father's Cell *

Father's Email *

Occupation

Marital Satus *

Married
Divorced
Other

Second Address

Address Line 1

Address Line 2

City

State

Zip Code

Programs

Friends@Home

Once a week throughout the school year, Friends@Home accommodates a wide variety of schedules. Friends@Home pairs two teenage volunteers and children with special needs for hours of fun and friendship through weekly home visits. This provides children the chance to bond with their volunteers in an environment they are most comfortable in, while their parents and siblings receive much-needed respite. Through 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.

I WOULD LIKE TO JOIN FRIENDS@HOME: *

Please provide your first choice of time for the Friends@Home visit. *

Friends@Home is a one-hour program.

Please provide your second choice of time for the Friends@Home visit. *

Friends@Home is a one-hour program.

Comments

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

Friends Name *

First

Last

Are you able to arrange transportation to and from your special friend's home? *

Sunday Circle

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

I WOULD LIKE TO JOIN SUNDAY CIRCLE: *

Sports Circle

Sports Circle is a weekly sports program offering children with special needs ages 9 -15 the opportunity to learn essential team building, physical development, and much more while having amazing volunteer friends. Volunteers will help participants engage in the sports and create positive energy for their special friends. Sports Circle will start in November and take place weekly on Wednesdays from 3:30 - 4:30.

I WOULD LIKE TO JOIN SPORTS CIRCLE: *

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

Please note your friend will be required to register as well.

Friends Name

First

Last

Volunteers have the opportunity to be involved in much more!

Family & Holiday Events

Seasonal family programs provide fun and entertainment for families in the special needs community. Volunteers will help set up, manage the stations, and hang out with friends.

SAVE THE DATE! Our first Walk4Friendship - 2023

We are planning our first fundraiser to help raise the critical funds needed to continue our programming! Volunteers are encouraged to get actively involved by; inviting friends and family to participate, helping out at the carnival and walk in different capacities, and even creating a fundraising team.

Check here if you would like to join the Walk4Friendship Volunteer team.

Communication

It is essential to communicate in a timely manner, and we thank you in advance for all you do and the time you give to make it all possible. Friendship House will send out program updates and relevant info via text (as well as email).

Medical Information

Emergency Contact *

First

Last

*In case of emergency, when neither parent can be reached, please provide the name of a person who will assume responsibility for volunteer.

Relationship to Member *

Emergency Contact Phone *

Emergency Care *

In case of emergency requiring emegency care, I authorize the paramedics to take member to the nearest hospital, if necessary.

Health Insurance Provider

Health Insurance ID Number

Physician Name

First

Last

Physician Phone

Additional Medical Information

Any additional medical information that would be helpful for us to know in case of emergency

Allergies & Dietary Restrictions:

I hereby give my child/self permission to participate in Friendship House programs *

I permit my child/self's photo to be used for promotional purposes *

Yes, I do.
No, I do not.

please note Friendship House will not tag or use your name unless we reach out to you first and receive permission.

Pickup Permission

First

Last

I hereby give permission to the following person to pick up my child from any Friendship House activity.

Pickup Permission Relationship to Member

Pickup Phone

Liability Waiver *

First

Last

By typing my name above, I release Friendship House Corporation, its providers, and administrators from all liability for any incidence which affect the health, welfare, or safety of my child/self while participating in Friendship House Programs.

Signature Date & Time *

//Date

Time

Email Signup

I would like to recieve news & updates via email

Volunteer Registration

Once you register, to get to know you better and pair you with your special friend, we will be in touch to set up a short meeting with Itta to ensure you have the most rewarding experience possible.

References

Parent Information

Programs

Friends@Home

Sunday Circle

Sports Circle

Volunteers have the opportunity to be involved in much more!

Family & Holiday Events

SAVE THE DATE! Our first Walk4Friendship - 2023

Communication

Medical Information

Friendship House

ABOUT

Volunteer Registration

Once you register, to get to know you better and pair you with your special friend, we will be in touch to set up a short meeting with Itta to ensure you have the most rewarding experience possible.

References

Parent Information

Programs

Friends@Home

Sunday Circle

Sports Circle

Volunteers have the opportunity to be involved in much more!

Family & Holiday Events

SAVE THE DATE! Our first Walk4Friendship - 2023

Communication

Medical Information

Friendship House

Join Our Email List

ABOUT