| Volunteer Information |
| First Name |
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| Last Name |
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| Birthday |
|
| Gender |
Male / Female |
| Street Address |
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| City, State, Zip |
|
| Home Phone |
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| Cell Phone |
cell carrier
|
| Email |
|
| School |
|
| Grade |
|
| Congregation |
|
| Parent's Information |
| Father's Name |
|
| Email |
|
| Cell |
|
| Occupation |
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| Mother's Name |
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| Email |
|
| Cell |
|
| Occupation |
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Refrences -
List two references of people who are not related to you |
| #1 reference |
Name
Phone
|
| #2 reference |
Name
Phone
|
| Parental Permission |
|
I hereby permit my son/daughter permission to participate in Friendship Circle programs.
I permit my son/daughter's photo to be used for publicity purposes.
I hereby release the Friendship Circle, its providers and administrators, from ALL liability for any incident which affects the health, welfare, or safety of my child in the provision of a Friendship Circle program for the year 2013/2014.
|
| Programs I'm interested in Volunteering for: |
|
Friends at Home - once a week throughout the school year
|
| |
First Choice Day of the Week |
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| |
First Choice Time of the Day |
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Second Choice Day of the Week |
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Second Choice Time of the Day |
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Torah Circle: two Sundays a month, 1:00 - 3:30p.m.
(at the JCC in Rockville)
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|
Teen Scene: two Sundays a month 1:00- 3:30pm
(runs parallel to Torah Circle at the JCC in Rockville) |
|
Holiday Programs |
