“Friends Helping Friends ”

VOLUNTEER INFORMATION
Name : *
Birthday : *
Address : *
City : *
MA :
Zip : *
Home Phone : *
Cell Phone :
Email : *
School : *
Grade : *

54 South Street

Westborough , MA 01581

(508)366-0499

www.fc.chabadwestboro.org

ADDITIONAL INFORMATION
  PARENT'S NAME :* PARENT'S CELL NUMBER :*
  When would you like to volunteer at the home of a child with special needs?
 
FIRST CHOICE:* TIME : *
SECOND CHOICE:* TIME : *
 
  Do you have friend with whom you can volunteer ? * Yes No
  FRIEND'S NAME* PHONE NUMBER :*
 
  Are your parents available to drive you TO or FROM the child’s home?* Yes No
      Yes No
 
  Please list one reference, who is not a relative.  (For New FC Volunteers Only). *
 
Name :* Relationship:*   Phone : *
PARENTAL CONSENT
  I give my teen permission to volunteer in the Friendship Circle* YES NO
  I give permission for my teen’s photo/s to be used for publicity purposes* YES NO
  I (Parent of the Volunteer), would be interested in assisting the Friendship Circle in future events.* YES NO