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BrownstoneFriendshipCircle.com » Volunteers » Volunteer Registration Form
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 Sign Up to Volunteer

Volunteer Information

Name

 

Age

 

Birthday

 

Street Address

 

City, State, Zip

 

Home Phone

 

Cell Phone

 

Email

 

School

 

Grade

 



 

Additional Information

Mother’s Name

 

Cell Phone

 

Fathers Name

 

Cell Phone

 

Do you have a friend with whom you’d like to volunteer with?

 Yes   No

If yes, Friends Name

 

Friends Phone

 

Please List 2 References (may not be a relative):

 

Reference 1: Name

 

Relationship

 

Phone

 

Email

 

Reference 2: Name

 

Relationship

 

Phone

 

Email

 


 

 

 

 

  

 

 

 

 

 

 

 

 

 

 

 

 

  

Medial Information

 

Emergency Contact Information (other than parent)

 

Name

 

Relationship

 

Phone

 

Please list any allergies or medical conditions we should be aware of:

 

 

 

 

 

 

 

 

 

 Parental Consent- Requried

 

  

I give my teen permission to volunteer with the Friendship Circle

     

I would like to assist as a volunteer at Friendship Circle programs

      Yes    No

Signature of Parent

 

Date

 


 

 

 

 

 

 

 

Volunteer Consent - Required



  

I agree to keep all information about my special friend confidential

      

In the event that I am unable to volunteer, I will notify the office and my special friend ASAP, and will try to find a substitute.

      

I agree to submit a weekly report of my Friends @ Home visit (including the time spent and the summary of my visit)

      

Signature of Volunteer

 

Date

 


 

 

 

 

 

 

 

 

 

 

 

 

 

I Would Like to Sign Up For:

Friends of Home

 

I would like to sign up for Friends at home

 

First Choice Day of Week

 

 

First Choice Time

 

 

Second Choice Day of Week

 

 

Second Choice Time

 



 





 


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