24'-25' New Volunteer Application

BS"D
24'-25' 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:*

New VolunteerReturning Volunteer
Returning Volunteers, please use our Volunteering Opportunities Form to update your information and make your program selections.
DOWNLOAD OUR NEW PROGRAMS GUIDE HERE
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Please Note: This form is for volunteers who are in the 8th grade and up, adults, and MVP graduates. If you are in the 6th or 7th grade, you must first attend the Mitzvah Volunteer Program (MVP). Please click here for the MVP form.
Have you attended a New Volunteer Orientation yet?*

Yes, I've attended a New Volunteer OrientationNo, I haven't attended a New Volunteer Orientation
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

MaleFemale
Today

MonthDayYear
Date
Current Age
Current Age of Volunteer
Email*
example@example.com
Mobile Phone*
Home Phone
Have you moved this year?

YesNo
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

YesNoSometimes
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?

YesNot yet, but I'm planning toNo
Please upload a picture of yourself:

Cancelof
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)
Mother's Mobile Phone*
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
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)
Father's Mobile Phone*
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
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

Clear
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

Clear
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*
Emergency Contact Phone#2*
Doctor*

First NameLast Name
Doctor's Phone Number*
Insurance Information
Insurance Carrier & Policy Number*
Insurance Phone Number*
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.I 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 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;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.
SAFETY & WELL BEING AGREEMENT: Parent/Guardian Signature*

Clear
SAFETY & WELL BEING AGREEMENT: Volunteer Signature *

Clear
Parental Consent and Volunteer Agreement
Volunteer Consent Agreement
- 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*

Clear
- I understand that community service or fellowship points will only be issued 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.
VOLUNTEER AGREEMENT: Volunteer Signature *

Clear
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*

Clear
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.
Should be Empty:

24'-25' New Volunteer Application

Volunteer Information

Returning Volunteer Information

Parents/Guardian Information

Medical & Trip Declaration

Insurance Information

Commitment to Safety & Well-Being

Parental Consent and Volunteer Agreement

Volunteer Consent Agreement

Release to Perform Background Check

Personality & Preferences

References