Volunteer Information
First Name Last Name
Birthday Gender
Address City
State Zip
Graduating Year
Home Phone Cell Phone
Email Do you have Facebook?

Best way to reach me
Parent Contact Information
Mother's Name Father's Name
Mother's Email Father's Email
Mother's Cell Father's Cell
Additional Information
When would you like to volunteer at the home of a child with special needs?
First Choice Day of Week Time
Second Choice Day of Week Time
Program of Choice:    
Do you have a friend with whom you would like to volunteer? Yes No
Your Friend's Name Phone Number
Please select which times (if any) your parents are available to drive you to or from your friend's home

To From

Please list any activities you will not be able to participate in due to a limitation or medical condition that we should be aware of:
Please list any additional concerns or information our staff should be aware of in order to ensure your safety
Please list one reference who is not related:
Name Relationship

In case of an emergency please contact:
Name Relationship
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 log my hours after 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.

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

I (Parent of the Volunteer), would be interested in assisting the Friendship Circle in future events.
By submitting this form I am agreeing to the information and signing this form electronically.