Volunteer Registration Please apply only if you think you are responsible enough and will be committed. Your Information First Name:* Last Name:* Age:* Month Day Year Date of Birth:* 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 19 Address:* City:* Postal Code:* Telephone:* Cell phone: Email:* School:* Grade:* I consider myself:* Quiet Average Loud Additional Information Mother's Name:* Title: Mother's Cellphone: E-mail: Father's Name:* Title: Father's Cellphone: E-mail: Religion:* I understand that to receive a signature on a Community Service form I must send in a weekly email about my visits. Medical Information Emergency Contact Name (other than a parent):* Phone:* Relationship:* Cellphone: Please list any allergies:* Please list any medical conditions that we should be aware of:* Parental Consent This section must be approved by a parent before proceeding to the completion of the form. I give my teen permission to volunteer in the Friendship Circle. I give my teen permission to attend Friendship Circle trips. I agree that my teen’s photos may be used for any and all Friendship Circle publicity purposes. I would like to volunteer for: Friends @ Home When would you like to volunteer at a special needs child’s home? 1st choice Day of the week: Sunday Monday Tuesday Wednesday Thursday Friday Saturday Time: 2nd choice Day of the week: Sunday Monday Tuesday Wednesday Thursday Friday Saturday Time: Do you have a friend with whom you'd like to volunteer? Yes No If yes please provide your friend’s name: Are your parents available to drive you to or from a child’s home? Yes No Volunteer Opportunities Friends at Home Bowling League Community Adventures Get Moving You are what you Eat I have other talents that I would like to share with the children Please specify: I agree to keep all information about my circle friend and their family confidential. In the event that I am unable to volunteer I will try to find another day to substitute and I will call my special friend in advance. In the event that I am unable to attend Bowling League I will try to find a substitute volunteer and I will call the office in advance. This page uses 128 bit SSL encryption to keep your data secure.