Friends@Home – Families

An extraordinary program that provides your child with the chance to bond with their volunteers in a setting in which they are most comfortable, their own homes. Volunteers work with their special friend and their families to establish a schedule that works for both. With so much to look forward to, these visits are cherished by both the children and volunteers.

Step 1 of 2

Child Information

Name *

First

Last

Date of Birth *//

Jewish *

Grade *

Address *

Address Line 1

City

State

Zip Code

Cell Phone

Child's Email Address

School Attending *

School Phone Number *

Additional Information

Father's Name *

First

Last

Father's Cell Phone *

Father's Email Address *

Mother's Name *

First

Last

Mother's Cell Phone *

Mother's Email Address *

Prefrences

First Choice *

Second Choice *

What does your child enjoy doing most? (outdoor/indoor activities) *

Are there any fears you'd like us to know about (animals, loud noises, etc) and suggestions of how we can deal with them? *

Is there anything we need to know about your child? *

How did you hear about our program? *

Is your child completely toilet trained? *

Does your child need reminders to go to the bathroom? *

I agree that a parent/guardian will be home while volunteers are interacting with my child. *

I release the Friendship Circle, its providers and administrators, from all Liability for any incident which affects the health, welfare, or safety of my child in the provision of such service. *

I permit my child’s photos to be used for publicity purposes *

Signature *

Comment

Friends@Home – Families

Child Information

Additional Information

Prefrences

Friendship House

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Child Information

Additional Information

Prefrences

Friendship House

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