New Volunteer Registration – Friendship Circle FL

Volunteer Registration

First Name *

Last Name *

Birthday *

Contact Information

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Cell Phone Number *

Email *

Religion *

School/Occupation *

Grade

Medical Information

Allergies/medical concerns *

Emergency Contact Name (First Name, Last Name) *

Phone Number *

Cell Phone *

Do you have any experience in volunteering for the special needs community? options: Yes, No If yes, kindly elaborate. *

References

Please list 2 non-family references:

Reference 1

Full Name / Phone / Connection

Reference 2

Full Name / Phone / Connection

Parent Information

Required for volunteers under age of 18.

Mother's Name (First Name, Last Name)

Mother's Cell

Occupation

Father's Name (First Name, Last Name)

Father's Cell

Occupation

E-mail

Marital Status

Single
Married
Divorced

Programs

TEEN SCENE

>Sunday, twice a month, 3:00-4:30 PM
Teen volunteers and teens with special needs get together monthly for social activities and group "hang outs", where they can have a great time while enhancing their social skills!

YOUNG ADULT CIRCLE

>Thursday, twice a month, 6:00-7:30 PM
Young adult volunteers and young adults with special needs come together monthly to form a social group in a non-judgmental and accepting environment. They get to experience an exciting array of activities such as karaoke, art, baking, sports and so much more.

CULINARY CLUB

>One Sunday a month, 4:00-5:00 PM
Travel the world & discover different yummy cuisines with fun, talented chefs!! Socialize with friends, discover your hidden talents, and come home with deliciousness and lots of pride!!

FRIENDS AT HOME

>Once a week throughout the school year, accommodates a wide variety of schedules (Open for families who are a part of our Teen Scene Program)
Friends@Home pairs teenage volunteers and children with special needs for hours of fun and friendship through weekly home visits. This provides children the chance to bond with their volunteers in an environment they are most comfortable in, while their parents and siblings receive much-needed respite.

Through the weekly visits, the pair establishes a warm friendship that combats the loneliness and isolation so often felt by individuals with special needs while their teen volunteers learn the priceless value of giving.

LIFE SKILLS & JOB TRAINING PROGRAM

Monday- Friday, 9:00 A.M- 3:00 P.M. Our goal is to provide our Adults with special needs with an immersive, real- world environment where they can practice critical life and job skills. The program includes hands on training in The Friendship Cafe, interpersonal & communication skills, academics such as basic math & reading, Yoga & relaxation techniques, a Mentorship program, Arts & more.

For Friends at Home and or Life Skills & Job Training Program - Which days and times work best for you?

I would like to volunteer for the following *

Permission and Waivers

Photos *

I grant The Friendship Circle and its partners permission to use my / volunteer's name, image, likeness, or recording for publicity purposes.

Medical *

I do hereby agree not to hold The Friendship Circle nor Las Olas Chabad Jewish Center, Inc. liable for any injury, loss, or theft that may occur during the participant’s / volunteer's involvement at a Friendship Circle event. I hereby give my permission to the Friendship Circle to secure necessary treatment including but not limited to anesthesia and hospitalization in the event of any such injury to the participant, should a staff member of the Friendship Circle or Las Olas Chabad Jewish Center, Inc. deem it necessary. I hereby give my permission to such person to engage on my behalf and on behalf of the participant, to transport the participant to a hospital if necessary. I have indicated to Friendship Circle all pertinent medical information regarding the participant.

Liability *

I do hereby agree not to hold The Friendship Circle nor Las Olas Chabad Jewish Center, Inc. or their agents, volunteers, and other participants liable for any injuries or damages which may occur in any Friendship Circle event and to and from such events. I hereby waive all rights to sue The Friendship Circle and/ or Las Olas Chabad Jewish Center, Inc. for any such incidents which may occur including but not limited to the transit to and from The Friendship Circle events.

Code of Conduct *

I have carefully read and agree to abide and be bound by all additional rules and policies in the Friendship Circle Code of Conduct and any additional rules pertinent to specific events. THE FAILURE TO ABIDE BY THE CODE OF CONDUCT & ANY SUCH RULES MAY, IN THE EXERCISE OF FRIENDSHIP CIRCLE’S SOLE AND ABSOLUTE DISCRETION, RESULT IN THE TERMINATION OF ALL FURTHER PROGRAM ACTIVITIES.

Friendship Circle of Greater Fort Lauderdale provides very special and unique opportunities for volunteers, special friends, and their families to enrich the lives of each other. In doing so, most participants will encounter new and sometimes challenging situations. Thus, it is imperative to set expectations at the beginning so that volunteers, special friends, and parents understand what they can expect. Therefore, volunteers, special friends, and their families each certify and agree by signing below that they:
As a Parent/Guardian of a special needs child of Friendship Circle or a volunteer:

● I understand that Friendship Circle will match my child with a teenage/ young adult volunteer.
● I understand that it is necessary for me as parent(s)/guardian(s) to assume full oversight and supervision responsibilities with respect to all activities Friendship Circle’s assigned volunteer(s) share(s) with my child in connection with his/her participation in the program.
● I understand that participation in this activity is entirely voluntary and requires participants to abide by applicable rules and standards of conduct;
● I understand that participation in Friendship Circle activities involves a certain degree of risk, both physically and emotionally demanding. I have considered the risk involved and have given consent as indicated below for my participation
Will not use or possess any illegal drug, alcohol or controlled substances at any time, including at Friendship Circle events or programs;
● I will not bring any weapons, firearms or other dangerous items to any Friendship Circle event or program and I will not have any unsecured firearms in a home in which hosts a Friends at Home program;
● Have not and do not have any individual that has been convicted of a crime, other than minor traffic violations, living at or visiting a home that hosts a Friends at Home program and have not themselves been convicted of a crime;
● Do not themselves have and do not have any individual that has a history of violence or abuse of any kind living at or visiting a home that hosts a Friends at Home program;
● Acknowledge the risk of injury from activities involved in Friendship Circle events and knowingly and freely assume all such risks. In the event I observe any particular hazard that I believe could cause injury to a participant, I will immediately inform Friendship Circle staff of such hazard.;
● Will not participate in any activity that you believe you and/or your child cannot perform in accordance with the Friendship Circles activities’ instructions or in a safe manner;
● Agree Friendship Circle is not responsible for any damage or injury to myself, my child/participant or my property in regard to my participation in any Friendship Circle activity;
● Acknowledge that Friendship Circle is an independently owned, operated and controlled local corporation.

I have carefully read and agree to abide and be bound by all additional rules and policies in the Friendship Circle Handbooks and any additional rules pertinent to specific events. THE FAILURE TO ABIDE MAY, IN THE EXERCISE OF FRIENDSHIP CIRCLE’S SOLE AND ABSOLUTE DISCRETION, RESULT IN THE TERMINATION OF ALL FURTHER PROGRAM-RELATED VISITATIONS WITH YOUR CHILD.

You may also access a copy of Friendship Circle Code of Conduct here.

*If volunteer is over 18, they can sign. If volunteer is under 18, the volunteer’s legal guardian must sign. Your typed name below signifies your electronic signature. The Friendship Circle accepts your electronic signature in place of a handwritten signature on a hard copy page.

Authorized Signature (Volunteer > 18 yo or Legal Guardian) *

Name of Authorized Signatory *

First

Last

Relationship to the Volunteer (write self if Volunteer > 18 yo) *

Date Today *