New Volunteer Application

BS"D
26'-27' New Volunteer Application
Thank you for your interest in volunteering with us. Please fill out the form below and one of our coordinators will be in touch. More Info? Email Liam@fcla.org.

Let's get started:
I am a:
Returning Volunteers, please use our Volunteering Opportunities Form to update your information and make your program selections.
⭐ Please Note! ⭐ This form is for volunteers who are in the 8th grade and up, adults, and MVP graduates. Want to apply to our MVP Program for 6-8th graders? Click here for the MVP form.
Full Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Have you attended a New Volunteer Orientation yet?
Please note: New volunteers are required to attend a New Volunteer Orientation meeting before beginning to volunteer. After you complete filling this application, information on how to book your New Volunteer Orientation will be emailed to you.
Volunteer Information
Returning Volunteer Information
Hebrew Name
Your Jewish Name
Gender
Today

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Current Age
Current Age of Volunteer
Email
This will be the email address we will use for all correspondence, including the status of your application.
Mobile Phone
Format: (000) 000-0000.
Home Phone
Format: (000) 000-0000.
Have you moved this year?
Address

Street Address

Street Address Line 2

CityState

Zip Code
Please provide your new address:

Street Address

Street Address Line 2

CityState

Zip Code
School Attending
Year Graduating from High School
Are you/your family affiliated with a synagogue
If yes, which Synagogue?
List any/all Youth Groups with which you are affiliated (if none, type 'none')
Did you have a Bar-Mitzvah/Bat-Mitzvah?
Please upload a picture of yourself:

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Parents/Guardian Information
Parent/Guardian Status
Volunteer Lives With:
Mother's Name

First NameLast Name
Mother's Hebrew Name
Home Address (if different than volunteer's)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone (if different than volunteer's)
Format: (000) 000-0000.
Mother's Mobile Phone
Format: (000) 000-0000.
Mother's Occupation
Mother's Place of Employment
Mother's Work Address

Street Address

Street Address Line 2

CityState

Zip Code
Mother's Work Phone
Format: (000) 000-0000.
Mother's Email
example@example.com
Father's Name

First NameLast Name
Father's Hebrew Name
Home Address (if different than volunteer's)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone (if different than volunteer's)
Format: (000) 000-0000.
Father's Mobile Phone
Format: (000) 000-0000.
Father's Occupation
Father's Place of Employment
Father's Work Address

Street Address

Street Address Line 2

CityState

Zip Code
Father's Work Phone
Format: (000) 000-0000.
Father's Email
example@example.com
Medical & Trip Declaration
Volunteer's Legal Name

First NameLast Name
Medical: As the parent/legal guardian of {fullName3}, I authorize any adult acting on behalf of Friendship Circle Los Angeles to hospitalize or secure treatment for my child 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}, to attend and participate in all trips and outings organized as part of the program by Friendship Circle.
Medical & Trip Agreement: Parent/Guardian Signature
Medical: I authorize any adult acting on behalf of Friendship Circle Los Angeles to hospitalize or secure treatment for myself 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 to attend and participate in all trips and outings organized as part of the program by Friendship Circle.
Medical & Trip Agreement: Volunteers over 18 years old
Any presenting medical conditions or allergies? If yes please list medications and frequency (if none, type 'none').
Emergency Contact Name

First NameLast Name
Relationship to Volunteer
Emergency Contact Phone#1
Format: (000) 000-0000.
Emergency Contact Phone#2
Format: (000) 000-0000.
Doctor

First NameLast Name
Doctor's Phone Number
Format: (000) 000-0000.
Insurance Information
Insurance Carrier & Policy Number
Insurance Phone Number
Format: (000) 000-0000.
Subscriber Name:
Commitment to Safety & Well-Being
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)

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 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. I acknowledge the risk of injury from the activities involved in the Friendship Circle events or program and knowingly and freely assume all such risks. I will not allow me/my child to participate in any activity that I believe you I/or my child cannot perform in accordance with the Friendship Circles activities’ instructions or in a safe manner. If I observe any significant hazard during your participation in any Event, I will stop participating in the event and inform the Friendship Circle of such hazard immediately.In case of emergency involving me/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 volunteer, follow-up and communication with the volunteer’s parents or guardian, and/or determination of the volunteer’s ability to continue in the program activities;
SAFETY & WELL BEING AGREEMENT: Volunteer Signature
SAFETY & WELL BEING AGREEMENT: Parent/Guardian Signature
VOLUNTEER AGREEMENT: Volunteer Signature
PARENTAL CONSENT: Parent/Guardian Signature
Release to Perform Background Check

Only required for Volunteers 18 and older
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
Personality & Preferences

In an effort to match you with a child that is most suitable for you, please complete the questions below. This is not a test – just our way of getting to know you better!
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 challenging and 10 being the most challenging, how challenging of a kid are you comfortable with?
References
Please note: 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. Instructions on how to submit your reference forms will be shared with you once you submit this form.
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26'-27' New Volunteer Application

Volunteer Information

Returning Volunteer Information

Parents/Guardian Information

Medical & Trip Declaration

Insurance Information

Commitment to Safety & Well-Being

Release to Perform Background Check

Personality & Preferences

References