Teen Volunteer Information Full Name* First Name Last Name Birth Date* 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Month 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 Day 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Year Address* Street Address Street Address Line 2 City State / Province Postal / Zip Code Please Select United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile People's Republic of China Republic of China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia Spain Sri Lanka Sudan Suriname Svalbard Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other 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* Parent Contact Information 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* Married Divorced Separated Single If Divorced Child Lives With Mother Father Grandparent(s) Relative What Programs Interest You? 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. 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 Week Time 1 2 3 4 5 6 7 8 9 10 11 12 Hour 00 10 20 30 40 50 Minutes AM PM Second Choice: Day of the Week Time 1 2 3 4 5 6 7 8 9 10 11 12 Hour 00 10 20 30 40 50 Minutes AM PM 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 Please list one reference who is not a relative. (For New FC Volunteers Only) Full Name First Name Last Name Relationship Phone Number Area Code Phone Number 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 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 Volunteer 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 Consent 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 Submit Should be Empty: This page uses TLS encryption to keep your data secure.