Volunteer Registration Form

Name:

School: Year Level:

Cell Phone Number: Home Number:

Email Address:

Address: City: Zip:

Best way to contact me is: Cell Phone Number Email Text Message Facebook

I am interested in volunteering at the Friendship Circle of Parkland/ Boca Raton (and surrounding areas) Friendship Circle of West Boynton Beach/ West Lake Worth Both Friendship Circle locations

Medical Information:

Volunteer Name: Date of birth:

Allergies:

Additional information:

In case of an emergency please contact: Relationship:

Home Phone Number: Cell Phone:

Friendship Circle Programs

Please check off which programs you wish to participate in:

Friends at Home (weekly) Lifeskills (once a month) Holiday Programs (every other month)

Teen Scene Sunday Circle (twice a month) Winter Camp (4 days)

Friendship Cafe (once a month) Special Strides (twice a year, 1 day a week for 5 weeks)

West Boynton Beach / West Lake Worth Friendship Circle Programs

Please check off which programs you wish to participate in:

Friends at Home (weekly) Holiday Programs (every other month)

Sunday Circle (once a month)

If you would like to sign up for FRIENDS AT HOME please fill out the box bellow:

Have you ever participated in friends at home in the past?

If so, what was the name of the child/family?

Would you like to continue visiting that family?

Do you have a friend with whom you would like to do Friends at Home?

(Please write three choices in order of preference)

1.

2.

3.

What time works best for you to Friends at Home?

We will be in touch with you shortly.

Thank you for joining the Friendship Circle, and for being a part of helping change the life of a child with special needs!!