(under 18)

Full Name*

First Name Last Name

Birth Date*

Month Day Year

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Phone

Area Code Phone Number

Teen Cell Phone*

Area Code Phone Number

Teen E-mail*

School*

Religion*

Grade*

Gender*

Male Female

Where did you hear about Friendship Circle*

Mother's Name

First Name Last Name

Mother's Email

Mother's Cell

Area Code Phone Number

Mother's Occupation

Father's Name

First Name Last Name

Father's Email

Father's Cell

Area Code Phone Number

Father's Occupation

Parent's Marital Status*

If Divorced Child Lives With

Friends @ Home

Volunteers 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 Circle

Join 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 Circle

Join 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 Camp

Join 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 Buddies

Basketball 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 Stars

Soccer 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.

Tennis

Tennis 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 Friends

This 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.

First Choice: Day of the Week

Time

Hour Minutes

Second Choice: Day of the Week

Time

Hour Minutes

What are your hobbies or special interests?

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

Yes No

Friend's Name

First Name Last Name

Friend's Number

Area Code Phone Number

Are your parents available to drive you to and from the child's home?

Yes No

Full Name

First Name Last Name

Relationship

Phone Number

Area Code Phone Number

Full Name

First Name Last Name

Relation

Phone Number

Area Code Phone Number

In case of medical emergency requiring immediate emergency care, I authorize the paramedics to take my child to the nearest hospital if necessary

Yes No

Health Insurance Name

Phone Number

Area Code Phone Number

Allergies

Medical Concerns

*

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.

I give my teen permission to volunteer in the Friendship Circle*

Yes No

I give permission for my teen's photo/s to be used for publicity purposes.*

Yes No

I (Parent of the Volunteer), would be interested in assisting the Friendship Circle at future events*

Yes No

Teen Volunteer Form

(under 18)

Teen Volunteer Information

Parent Contact Information

What Programs Interest You?

If you are interested in volunteering at the home of a child with special needs (Friends @ Home), please answer the following:

Please list one reference who is not a relative.

Medical Information

Volunteer Agreement

Parental Consent