Teen Volunteer InformationFull Name*First NameLast NameBirth Date*1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearAddress*Street AddressStreet Address Line 2CityState / ProvincePostal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOtherCountryHome PhoneArea CodePhone NumberTeen Cell Phone*Area CodePhone NumberTeen E-mail*School*Religion*Grade*Gender*MaleFemaleWhere did you hear about Friendship Circle*Parent Contact InformationMother's NameFirst NameLast NameMother's EmailMother's CellArea CodePhone NumberMother's OccupationFather's NameFirst NameLast NameFather's EmailFather's CellArea CodePhone NumberFather's OccupationParent's Marital Status*MarriedDivorcedSeparatedSingleIf Divorced Child Lives WithMotherFatherGrandparent(s)RelativeWhat Programs Interest You?Friends @ HomeVolunteers get together with their special needs buddy in the child's home for 1 hr. every week or at least twice a month. This program provides the opportunity for teens to get to know their friend with special needs on a more personal level and build a relationship that last forever!Sunday CircleJoin us for 2 hours of fun and entertainment with a young child with special needs. At each Sunday Circle, you will join your buddy in an art class, play time and music. NOTE: Punctuality and commitment are very important!Young Adult CircleJoin us for 2 hours of fun at Young Adult Circle, where you and your buddy will learn life skills useful for an everyday basis! Our program includes everyday activities, social skills, cooking, shopping, adventures and entertainment, which simultaneously incorporate independence, laughter, and friendship that make for great memories.Winter/Summer CampJoin us for an experience that will last a lifetime! At the FC Winter/Summer Camps you will transform your vacation as well as the vacation of a child with special needs into an exciting camp experience with fun-filled activities, games, sports and field trips. Commitment: 5.5 hrs. each day for one week per camp.Basketball BuddiesBasketball buddies is a way that the volunteers and kids can be with each other while playing a sport they love. This program allows for the kids to be part of a team, and to learn the fundamentals of Basketball.Soccer StarsSoccer Stars pairs teen volunteer soccer players with kids, teens, and adults to teach them the fundamentals of soccer. They get to be part of a team and they play a scrimmage game each session. No prior experience is necessary to participate.TennisTennis is for ages 10+. Volunteers coaches teach the kids the sport of tennis. This program allows for the kids to learn a new sport they can play with their family and friends. We meet one Sunday a month from 11:00 am to 12:30 pm - see calendar for dates and location.Hangin' With FriendsThis program is for adults with special needs and volunteers 15+. This program will offer entertainment and fun activities that are more age appropriate for our young adults and provide them with even more opportunities to make new memories with their friends.If you are interested in volunteering at the home of a child with special needs (Friends @ Home), please answer the following:First Choice: Day of the WeekTime123456789101112Hour001020304050MinutesAMPM Second Choice: Day of the WeekTime123456789101112Hour001020304050MinutesAMPM What are your hobbies or special interests?Do you have a friend with whom you would like to volunteerYesNoFriend's NameFirst NameLast NameFriend's NumberArea CodePhone NumberAre your parents available to drive you to and from the child's home?YesNoPlease list one reference who is not a relative.(For New FC Volunteers Only)Full NameFirst NameLast NameRelationshipPhone NumberArea CodePhone NumberMedical InformationIn case of an emergency, when neither parent can be reached, please provide the name of someone who will take responsibility for your teenFull NameFirst NameLast NameRelationPhone NumberArea CodePhone NumberIn case of medical emergency requiring immediate emergency care, I authorize the paramedics to take my child to the nearest hospital if necessaryYesNoHealth Insurance NamePhone NumberArea CodePhone NumberAllergiesMedical ConcernsVolunteer Agreement*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*I will send in a report after every time I volunteer*In the event of a volunteer function I will try my hardest to attend however, regardless, I will always respond.Parental ConsentI give my teen permission to volunteer in the Friendship Circle*YesNoI give permission for my teen's photo/s to be used for publicity purposes.*YesNoI (Parent of the Volunteer), would be interested in assisting the Friendship Circle at future events*YesNoSubmitShould be Empty: This page uses TLS encryption to keep your data secure.