Printed from friendshipoc.org

Register Your Child

  • Child's Information

  • Parent Information

  • Help Us Get to Know Your Child a Little Better

  • Medical Information

    In case of an emergency, when neither parent can be reached, please provide the name of someone who will take responsibility for your teen
  • Medical Insurance Carrier

  • Parental Medical and Emergency Release

    My son/daughter has my permission to attend Friendship Circle events. I agree not to hold Friendship Circle liable for any accident, loss, or theft that may occur during the course of an event. I hereby give my permission to the physician selected by Friendship Circle to hospitalize, and/or secure necessary treatment or anesthesia for my child, as named above, in the event that I cannot be reached in an emergency. I hereby give my permission that paramedics can transport my child to the nearest hospital, if necessary. I have indicated any pertinent medical information above. I agree to the terms and conditions of this application. Additionally I am initialing below that I am agreeing to by my signature below.
  • Programs To Get Involved In

  • Friends at Home

    The Friends @ Home program gives children the chance to get to know their volunteers in an environment that they are most comfortable - their own homes. The volunteers generally visit for 1.5 hours weekly. Once we receive your form our coordinators will find an appropriate match for your child. The time frame for finding a match depends on age, location, and flexibility.
  • Days and Times that are good for you in order of preference:

  • If you already have a volunteer coming to the house, please fill out the following:

  • Group Activities and Programs

    (Check all that you would like to sign up for/receive information about)
  • Evening of Recognition

    I agree that I will attend the Friendship Circle Evening of Recognition each year. I understand that my attendance is vital in showing appreciation for the volunteer(s) who spend time with my child and that my presence is critical to the success of the program.
  • Pick a Date
  • Should be Empty: