2021-2022 New/Returning Volunteer Application

You are a:

New Volunteer Returning Volunteer

This form is for volunteers who are in the 8th and up, adults, and MVP graduates. If you are in the 6th or 7th grade, you must first attend the Mitzvah Volunteer Program (MVP) first. The MVP program has its own form. Please click here for the MVP form.

Have you attended a Volunteer orientation yet?

Yes No

New Volunteers are required to attend one orientation before beginning to volunteer. Learn more about who we are, what we do, and all our volunteering opportunities. Choose the program that’s best for you!

Here's is our schedule of orientations for this year:

10/14/2021
11/11/2021
12/9/2021
1/20/2022
2/17/2022
3/24/2022
4/28/2022
5/12/2022
7/7/2022

All Orientations take place at Friendship Circle of LA:

1952 S. Robertson Blvd.

Los Angeles, CA 90034

Time: 8:00pm-9:00pm

Attending a Volunteer Orientation earn you 6 Fellowship Points

To RSVP for an upcoming orientation please email Chjaya at chaya@fcla.org

Full Name *

Prefix First Name Last Name

Hebrew Name

Your Jewish Name

Gender *

Male Female

Date of Birth *

Date

Today

Date

Current Age

Current Age of Volunteer

Email *

example@example.com

Mobile Phone *

Area Code Phone Number

Home Phone *

Area Code Phone Number

Have you moved this year?

Yes No

Address *

Street Address

Street Address Line 2

City State

Zip Code

Please provide your new address: *

Street Address

Street Address Line 2

City State

Zip Code

School Attending *

Year Graduating from High School *

Are you/your family affiliated with a synagogue *

Yes No Sometimes

If yes, which Synagogue?

List any/all Youth Groups with which you are affiliated (if none, type 'none') *

Did you have a Bat/Bar-Mitzvah? (Choose option below) *

No Not yet, but I’m planning to Yes

Please upload a picture of yourself: *

Browse Files

Parent/Guardian Status *

Volunteer Lives With:

Mother's Name *

First Name Last Name

Mother's Hebrew Name

Home Address (if different than volunteer's)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Home Phone (if different than volunteer's)

Area Code Phone Number

Mother's Mobile Phone *

Area Code Phone Number

Mother's Occupation

Mother's Place of Employment

Mother's Work Address

Street Address

Street Address Line 2

City State

Zip Code

Mother's Work Phone *

Area Code Phone Number

Mother's Email *

example@example.com

Synagogue Affiliation (if different than volunteer's)

Father's Name *

First Name Last Name

Father's Hebrew Name

Home Address (if different than volunteer's)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Home Phone (if different than volunteer's)

Area Code Phone Number

Father's Mobile Phone *

Area Code Phone Number

Father's Occupation

Father's Place of Employment

Father's Work Address

Street Address

Street Address Line 2

City State

Zip Code

Father's Work Phone *

Area Code Phone Number

Father's Email *

example@example.com

Synagogue Affiliation (if different than volunteer's)

Volunteer's Legal Name *

First Name Last Name

Medical: As the parent/legal guardian of {fullName3}/self, I authorize any adult acting on behalf of Friendship Circle Los Angeles to hospitalize or secure treatment for my child/self and I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Friendship Circle personnel will try, but are not required, to communicate with me prior to such treatment.

Trips and Outings: I hereby give permission for my child {fullName3}/self, to attend and participate in all trips and outings organized as part of the program by Friendship Circle.

Medical & Trip Agreement: Parent/Guardian Signature (or volunteer over 18 years old) *

Clear

Any presenting medical conditions or allergies? If yes please list medications and frequency (if none, type 'none'). *

Emergency Contact Name *

First Name Last Name

Relationship to Volunteer *

Emergency Contact Phone#1 *

Area Code Phone Number

Emergency Contact Phone#2 *

Area Code Phone Number

Doctor *

First Name Last Name

Doctor's Phone Number *

Area Code Phone Number

Insurance Carrier & Policy Number *

Insurance Phone Number *

Area Code Phone Number

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Covid-19 Waiver to Participate

WAIVER, RELEASE AND HOLD HARMLESS

Friendship Circle of Los Angeles (“FCLA”) cares deeply about the health and well being of all participants. In consideration of being allowed to participate in any and all FCLA programs, related events, and activities and the use of FCLA facilities or enter and access FCLA (“the Programs”) I, the undersigned participant and/or on behalf of the participant acknowledge, understand, and agree that:

I am fully aware there are several risks associated with me participating in the Programs or entering, accessing, or otherwise using FCLA during a time of pandemic due to the novel coronavirus (“COVID-19”) that has been confirmed throughout the world, including COVID-19 cases in areas in which the Programs at FCLA may be located.

I understand that my potential exposure to COVID-19 through my participation in the programs, use of FCLA, or contact with other participants in the Programs or at FCLA. I also acknowledge that FCLA is not responsible for my safety against COVID-19 and makes no warranties, guarantees, or representations about the safety or condition of its facilities, employees, other participants, or third parties at FCLA.

I further acknowledge that, due to the nature of the activities associated with the Programs, social distancing of six or more feet between persons is not always possible and I may be placed in proximity to or come in contact with individuals, equipment, and/or surfaces that have been contaminated with or may transmit COVID-19 or other diseases. I fully understand and appreciate the known and potential dangers of participating in the Programs, including exposure to COVID-19, which could result in further transmission to others, quarantine, isolation, serious illness, disability, and/or death. I hereby agree my involvement and participation in the Programs is voluntary, and I knowingly, freely, unconditionally, and expressly assume any and all risks associated with the Programs and FCLA, including risks not known or reasonably foreseeable to me at this time.

I further acknowledge that wearing a mask or a face shield may be difficult for individuals with special needs and that there may be times when certain participants will remove the face coverings. This will actually serve as an opportunity for FCLA staff to teach life skills and the importance of wearing a face covering.

During my participation in the Programs, I agree I will conduct myself in a safe and reasonable manner, including by complying with all health and safety protocols and instructions provided to me in connection with the Programs and reporting and disclosing to FCLA any COVID-19 related symptoms (i.e. fever, cough, shortness of breath, chills, repeated shaking with chills, muscle pain, headache, sore throat and loss of sense of taste or smell) I may experience. I agree, represent, and warrant I will not enter, access, or otherwise use the FCLA facility if I experience COVID-19 related symptoms or test positive for or am otherwise diagnosed with COVID-19 or am exposed to anyone with COVID-19.

I, on behalf of myself, my heirs, executors, and any member of my family, hereby release, discharge, and hold harmless the Friendship Circle of Los Angeles and each of their officers, executives, officials, agents, employees, instructors, contractors, representatives and partners, as well as other participants, sponsors, advertisers, owners, and lessors of premises used for the Programs and related activities, from any and all claims, causes of action, demands or liability in any way relating to, or arising from the Programs and/or my use of the FCLA facility, including, without limitation, any personal or other injuries to third parties, property damage, or other adverse consequences or outcomes, whether foreseeable or not, whether caused by negligence or otherwise, including without limitation negligent decontamination or rescue operations. By signing this Release, I understand I may be giving up legal rights that I or others claiming through me may claim to have now or in the future and I am freely and voluntarily entering into this Release. In so doing, I hereby specifically waive the provisions of Section 1542 of the California Civil Code Section 1542, which provides as follows:

A general release does not extend to claims that the creditor or releasing party does not know or suspect to exist in his or her favor at the time of executing the release and that if known to him or her, would have materially affected his or her settlement with the debtor or released party.

This Release shall be binding upon me, my heirs and successors, assignees, personal representatives, and executors. This Release shall be governed by and construed according to the laws of the State of California, without regard to any conflicts of law principles. If any provision of this Release is deemed invalid, illegal, or unenforceable, it shall not affect the enforceability of any other term or provision of this Release. Rather, the invalid, illegal, or unenforceable provision shall be modified so that it is valid, legal, and enforceable and to the fullest extent possible, reflect the intention of the parties.

I HAVE READ THIS WAIVER & RELEASE OF LIABILITY IN ITS ENTIRETY, FULLY UNDERSTAND ITS TERMS, INCLUDING THAT I AM GIVING UP SUBSTANTIAL RIGHTS. I SIGN THIS DOCUMENT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME, AND INTEND BY MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT PERMITTED BY LAW.

PLEASE INDICATE HERE WHETHER YOU ARE OVER THE AGE OF 18 (Y/N) *

COVID-19 Waiver Signature of Parent/Guardian/Self *

Clear

Printed name of person signing *

Date *

Participant Name if other than self (full legal name):

I give my teen permission to volunteer at all Friendship Circle events.
I understand that community service or fellowship points will only be issued to my teen for hours submitted on a monthly basis, on our website or app.
I understand that community service hours will be submitted to your school per your request, with a 5-7 business day process time.

PARENTAL CONSENT: Parent/Guardian Signature *

VOLUNTEER AGREEMENT: Volunteer Signature

I hereby grant the Friendship Circle of Los Angeles permission to perform a background check on me as required by the law. This information will be kept confidential.

Social Security Number *

BACKGROUND CHECK CONSENT: Signature *

Walk4FriendshipLA 2021 - 10/24/2021

Walk and give your friends & family an opportunity to provide friendship for children/young adults who have special needs. Register, start a team, raise funds that will benefit our special children. Date: October 24, 2021. Time: 1:30pm-5:00pm. (8 Fellowship Points)

Walk4FriendshipLA Lawn Sign Placement

We would like to help FCLA advertise Walk4FriendshipLA and are happy to have a walk sign placed on our front lawn. (4 Fellowship Points)

Friends @ Home Participation - (2 Fellowship Points per visit)

Yes! Connect with a child or young adult with special needs once a week for an hour of friendship, fun and camaraderie! These meet-ups can be arranged to accommodate a wide variety of schedules. For: Volunteers 8th Grade+ No - I'm not interested

1st Choice: Day of the Week & Time

2nd Choice: Day of the Week & Time

Fear of pets? *

Yes No

If yes to fear of pets, which pets?

Any allergy to pets? *

Yes No

If yes to having an allergy to pets, which pets?

What area do you live in? *

How far can you/or your parent drive to a child’s house?

Sunday mornings come to life at an innovative program filled with Jewish educational, social and recreational fun. Volunteers and participants pair up to enjoy the experience together!

Volunteers are asked to commit to attend each week and give advance notice for absences to the program coordinator.

Torah Social:

For: Boy & Girl Volunteers 8th Grade+
Date: On 22 Sundays, September 12, 2021 - June 12, 2022

Time:

Track A: 9:00am-11:15am
Track B: 11:00am-1:15pm

Torah Social will be taking place in two locations:

Division A: Girls Volunteers

Location: Friendship Circle of Los Angeles

1952 S. Robertson Blvd.

Los Angeles, CA 90034

Division B: Boy Volunteers

Bais Chaya Mushka

9051 W. Pico Blvd.

Los Angeles, CA 90035

Please contact Morah Doonie Mishulovin if you have any questions: Doonie@fcla.org

Interested?

Yes I'm interested in volunteering at Torah Social No I'm not interested

Torah Social Volunteering has two Tracks

Track A Time: 9:00-11:15am - (3 Fellowship Points) Track B Time: 11:00am-1:15pm - (3 Fellowship Points) I want to volunteer at both tracks! - (6 Fellowship Points)

At Kicks & Hoops, kids and young adults with special needs get to experience the thrill of the sport firsthand! Coached by a professional and supported by a behaviorist, the children learn the rules of the game, develop teamwork and most of all, have fun!

For boy volunteers ages 12 and up

Wednesday Nights 6:30pm-8:00pm

Location: Friendship Circle of Los Angeles

1952 S. Robertson Blvd.

Los Angeles, CA 90034

Any questions: email Racheli at racheli@fcla.org

Kicks & Hoops Volunteering 10/6/2021 - 6/8/2022 (2 Fellowship Points per session)

Yes, I would like to volunteer for the Kicks & Hoops

At Girls' Scene, girls with special needs get to experience friendship, mentorship, recreation, and fun! Most importantly, a group of buddies is created!

For girl volunteers ages 12 and up

Monday Nights 6:30pm-8:00pm

Location: Friendship Circle of Los Angeles

1952 S. Robertson Blvd.

Los Angeles, CA 90034

Any questions: email Racheli at racheli@fcla.org

Girls' Scene Volunteering 10/11/2021 - 6/13/2022 (2 Fellowship Points per session)

Yes, I would like to volunteer for the Girls' Scene

Rosh Hashanah Festival:

For: Children and young adults who have special needs & their families

Date: Sunday, August 29, 2021

Time: 1:00pm-3:00pm

Location: Friendship Circle of Los Angeles

Chanukah Bash:

For: Children and young adults who have special needs & their families

Date: Tuesday, November 30, 2021

Time: 5:30pm-7:30pm

Location: Friendship Circle of Los Angeles

Tu Bishvat Fun!

For: Children and young adults who have special needs & their families

Date: Sunday, January 16, 2022

Time: 1:00pm - 3:00pm

Location: Friendship Circle of Los Angeles

Purim Extravaganza!

For: Children and young adults who have special needs & their families

Date: Thursday, March 17, 2022

Time: 5:30pm - 8:00pm

Location: Friendship Circle of Los Angeles

Matzah Bakery

For: Children and young adults who have special needs & their families

Date: Sunday, April 3, 2022

Time: 12:30pm - 1:30pm

Location: Chabad of Westwood

I'm interested in:

Rosh Hashana Festival (4 Fellowship Points) Chanukah Bash (4 Fellowship Points) Tu Bishvat Fun! (4 Fellowship Points) Purim Extravaganza! (4 Fellowship Points) Matzah Bakery (4 Fellowship Points)

Every day at Winter Camp is filled with great energy, exciting activities, and an awesome trip. The best part is that every camper experiences the week with their very own buddy.

Dates:

Week I - Mon-Fri - 12/20/2021 - 12/24/2021

Week II - Mon-Fri - 12/27/2021 - 12/31/2021

Required Volunteer Orientation: Sunday, 12/19/2021

Times: Winter Camp starts daily at 9:30 am and ends at 3:30 pm (1:00 on Fridays).

Locations:

Division A (all girls, boys ages 4-11):

Friendship Circle of Los Angeles

1952 S. Robertson Blvd. 90034

Division B (Boys ages 12 and up):

423 N. Fuller Ave. 90036

Summer Camp: TBD

(6 Fellowship Points per day of camp and 5 Fellowship Points for the Camp Orientation)

If you are interested or have any other questions, please contact Racheli Sabbagh.

Email: Racheli@fcla.org

Winter & Summer Camps I'm interested! Please send me more information about:

Winter Camp Summer Camp 2022 - TBD

November 6, 2021 - Time: 7:30pm-10:00pm - Location: Friendship Circle of Los Angeles - Boy and Girl Volunteers (4 Fellowship Points) December 11, 2021 - Time: 7:00pm-9:30pm - Location: Friendship Circle of Los Angeles - Boy and Girl Volunteers (4 Fellowship Points) January 29, 2022 - Time: 7:00pm-9:30pm - Location: Friendship Circle of Los Angeles - Boy and Girl Volunteers (4 Fellowship Points) February 26, 2022 - Time: 7:30pm-10:00pm - Location: Friendship Circle of Los Angeles - Boy and Girl Volunteers (4 Fellowship Points)

Volunteer Workshops

Volunteer Kickoff & Workshop I: Date: 10/17/2021 Times: Boys - 6:30pm-8:30pm Girls - 7:00pm - 9:00pm Location: Friendship Circle of LA (10 Fellowship Points) Volunteer Workshop II: January 9, 2022 - Boys - 6:30pm-8:30pm Girls - 7:00pm - 9:00pm Location: Friendship Circle of LA (10 Fellowship Points) Volunteer Workshop III : February 24, 2022 - Boys - 6:30pm-8:30pm Girls - 7:00pm - 9:00pm Location: Friendship Circle of LA (10 Fellowship Points)

Girls' Sushi & Shiur: Enjoy nights out with fellow volunteers, stimulating conversations, and great food! (In-Person) / For: Volunteers 8th grade+ / Time: 8:00-9:00pm / Location: Friendship Circle of LA Yard

Yes! I'm interested in Sushi & Shiur (2 Fellowship Points)

Boys' Wings & Wisdom: Enjoy nights out with fellow volunteers, stimulating conversations, and great food! (In-Person) / For: Volunteers 8th grade+ / Thursdays at 7:00pm, Location: Friendship Circle of LA Yard

Yes! I'm interested in Wings & Wisdom (2 Fellowship Points)

Girls' Pizza & Parsha: Enjoy nights out with fellow volunteers, stimulating conversations, and great food! (In-Person) / For: Volunteers 8th grade+ / Time: 8:00-9:00pm / Location: Friendship Circle of LA Yard

Yes! I'm interested in Pizza & Parsha (2 Fellowship Points)

Friendship Circle provides very special and unique opportunities for volunteers, special friends, and their families to enrich the lives of each other. In doing so, participants might 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 and a parent must each certify and agree by signing below that they: (please check each item showing acknowledgement) *

Understand that participation in this activity is entirely voluntary and requires participants to abide by applicable rules and standards of conduct; Understand that participation in Friendship Circle activities involves a certain degree of risk and can be physically, mentally, and emotionally demanding. I have carefully considered the risk involved and have given consent for me and/or my child to participate in this activity; Acknowledge the risk of injury from the activities involved in the Friendship Circle events or program and knowingly and freely assume all such risks; Will not allow me/my child to 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; If you observe any significant hazard during your participation in any Event, you will stop participating in the event and inform the Friendship Circle of such hazard immediately; Release Friendship Circle, the directors, board, officers, activity coordinators, and all employees, volunteers, related parties, and other organizations associated with the activity from any and all claims or liability arising out of this participation provided that care was taken to ensure safety; In case of emergency involving my child, I understand every effort will be made to contact me. In the event I cannot be reached, I hereby give my permission to the medical provider selected by the adult leader in charge to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for me/my child. Medical providers are authorized to disclose to the adult in charge examination findings, test results, and treatment provided for purposes of medical evaluation of the participant, follow-up and communication with the participant’s parents or guardian, and/or determination of the participant’s ability to continue in the program activities. I grant the Friendship Circle permission to use my or my child’s name, image, likeness, or recording in connection with any promotional materials including, but not limited to, brochures, advertising, and broadcasts.

I will promote the creation of a friendship community based on mutual respect and a sense of personal well-being. I will treat others with honor and respect because we are all created in the image of G-d. As a volunteer of Friendship Circle: (please check showing acknowledgement): *

I understand that Friendship Circle expects me to behave responsibly. I agree to utilize my best judgment and sense of responsibility when spending time with the child with whom I am matched. I understand that the use of a cell phone while volunteering does not promote a healthy friendship and should only be used in case of an emergency. Friends @ Home: In the event that I am unable to volunteer during my scheduled visit, I will try to find another day to substitute and I will notify the parents of my special friend, and my Friends @ Home coordinator at least 48 hours in advance. I agree to respect the privacy of all participants of the Friendship Circle and to keep personal information confidential. I understand that once I commit to attend an event, the Friendship Circle staff and special friends expect me to be there. I agree to attend and give it my best effort. In the event that I cannot attend, I agree to give notice to Friendship Circle staff, at least 48 hours in advance. If someone gets hurt or some other incident occurs while I am volunteering, it is my responsibility to immediately report the occurrence to Friendship Circle staff. I agree to represent the Friendship Circle to the best of my abilities. 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. I agree to volunteer for Friendship Circle. I grant Friendship Circle permission to use my name, image, likeness, or recording in connection with any promotional materials including, but not limited to, brochures, advertising, and broadcasts. I understand that participation in Friendship Circle activities involves a certain degree of risk and can be physically, mentally, and emotionally demanding. I have carefully considered the risk involved and agree to participate in this activity. I also understand that participation in this activity is entirely voluntary and requires participants to abide by applicable rules and standards of conduct as set forth in the Friendship Circle Handbook, as it may be modified from time to time. I understand that this local Friendship Circle is independently owned, operated and controlled. I release the Friendship Circle and its employees, directors, officers, and volunteers as well as its affiliates and all other organizations associated with Friendship Circle from any and all claims or liability arising out of this participation.

SAFETY & CODE OF CONDUCT AGREEMENTS: Parent/Guardian Signature *

SAFETY & CODE OF CONDUCT AGREEMENTS: Volunteer Signature *

Every Friendship Circle Volunteer is required to have two references.

Please detach the following 2 reference forms, have them completed and send them back to us via email, drop off at our office or fax them to 310-280-0974. Your application is complete only upon receipt of your reference forms.

Why have you chosen to volunteer at the Friendship Circle as opposed to other community service centers? *

Please tell us more about your personality. For example, What is your greatest strength or talent? What are your strongest character traits? *

What do you value most in a friendship that you are looking forward to sharing with a special friend? *

What hobbies or extra-curricular activities do you enjoy? *

Do you have a talent or hobby you might like to share with the children? *

What age children are you interested in working with? *

On a scale of 1-10, 1 being the least and 10 being the most, how challenging of a kid are you comfortable with? *

We require two reference forms to be submitted for your application to be complete. It can be a Rabbi, teacher or someone that is familiar with how you work with children. Simply direct them to the link below, or print the forms for them and email them to us.

REFERENCE FORMS MAY NOT BE FILLED OUT BY A RELATIVE

Reference Forms

Email for receiving receipts and confirmation of this application: *

example@example.com

Yes, I would like to make a donation to help sponsor a child in the amount of:

Enter amount above

Total

I would like to pay by:

Credit Card: form to follow below PayPal: donate@fcla.org Cash App: $FriendshipCircleLA Venmo: FCLAVen I will send a check

Donation Amount: *

USD

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Please make checks payable to to Friendship Circle of Los Angeles and mail to 1952 S. Robertson Blvd, Los Angeles CA 90034.

New Volunteer Information

Returning Volunteer Information

Parents/Guardian Information

Medical & Trip Declaration

Insurance Information

Parental Consent and Volunteer Agreement

Release to Perform Background Check

2021-2022 Volunteering Opportunities

Friends @ Home Program

Torah Social

Kicks & Hoops

Girls' Scene

Holiday Programs

Winter & Summer Camps (In-Person)

Saturday Night Fun

Volunteer Enhancement

Commitment to Safety & Well-Being

Volunteer Code of Conduct

Personality & Preferences

References (Required)

Sponsor A Child (Optional)