If you would like to chat about Friends@Home, please call call Rabbi Chayim B. Alevsky at 203-887-6044.

PLEASE FILL OUT THIS FORM TO THE BEST OF YOUR ABILITY. YOU WILL BE CONTACTED SOON AFTER SUBMISSION.

FAMILY REGISTRATION FORM FOR FRIENDS@HOME

Parent's Information
Mother's First Name Father's First Name
Mother's Last Name Father's Last Name
Cell Phone Cell Phone
Email Email
Street Address Street Address (if same as mother, skip to "Occupation")
City City
State State
Zip Zip
Occupation Occupation
Religious Affiliation Religious Affiliation
 
My Child's Information
Child's First Name Child's Last Name
Date Of Birth (MM/DD/YEAR) Gender
Street Address (if same as mother, skip to "home phone") City
State Zip
Home Phone School
Grade  

Please tell us a little about your child.

Some things that are good to know and may be helpful in arranging an appropriate volunteer match. ex. Specific behaviors, activities that your child likes or dislikes, etc..

 
 
Programs You Would Like To Join
Friends At Home (Weekly home visits by a pair of teen volunteers)

First Choice: Day

First Choice: Time
Second Choice: Day Second Choice: Time
Other Friendship Circle Programs (Holiday Programs, Sunday Circle, Etc.)
Teen Scene (Social outings and events for teens ages 13-18 with special needs. Pizza, bowling etc.)

Parent Handbook

Attached is the Parent Handbook. Please read it carefully and then initial the box below confirming that you read it and agree to abide by its rules.

PARENT HANDBOOK

I carefully read the Parent Handbook and agree to follow the rules stated within.

I give the Friendship Circle permission to use photos that may include my child at an event for publicity purposes.

PLEASE NOTE: All new families interested in joining Friendship Circle's Programs must have a meeting with the family coordinator. Upon submission of this form you will be contacted to set up a meeting.
We look forward to meeting you.

For more information please contact RabbiChayim@friendshipcirclews.org or call 203.887.6044.