Young Adult Volunteer Application 23-24

Layout

Name

Last Name

Layout

Birth Date

Email

Cell Phone Number

Occupation/place of employment

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Do you speak Spanish?

Yes, fluently
Yes, enough to have a conversation
No

How did you hear about our program?

Do you have any physical limitations that would impair your ability to perform as a volunteer without assistance?

Yes
No

If Yes, Please Explain

Social Security Number

Have you ever been arrested or convicted of a crime?

Yes
No

If Yes, Please Explain

Do you have family/friends who currently participate in programs Friendship Circle Miami?

Yes
No

If So, Please List Names

What organizations have you volunteered with in the past? Please let us know if you are a Friendship Circle Alumni volunteer!

Do you have any hobbies or talents you would like to share with our friends with special needs?

Personal Reference (Name and phone number)

Please upload a recent picture of yourself.

Click or drag a file to this area to upload.

Medical Information

Please provide information so that we can access appropriate medical care in case of an emergency.

Food allergies/reaction to medications

Any special medical circumstances

Current medications

Doctor's Name

Doctor's Phone Number

Preferred Hospital

Insurance Company

Member ID/Number

Emergency Contacts

Name

Layout

Phone Number

Relationship to volunteer

Name

Layout

Phone Number

Relationship to volunteer

By typing my name below, I understand that the Friendship Circle of Miami, Inc, including without limitation, any of its directors, teachers, employees, or agents, and including any volunteer, shall not be liable to any party for injury or damage, whether from acts of negligence or otherwise, in any way attributable to or in connection with such activities or field trips.

I permit my photo - without any identifying information - to be used for publicity purposes by The Friendship Circle and its partners, as it relates to Friendship Circle activities.

Yes
No

Code of Conduct

The Friendship Circle provides unique opportunities for volunteers, special friends, and both sets of families to enrich the lives of each other. In doing so, some participants may encounter new and sometimes challenging situations. Thus, it is imperative to set expectations in the beginning so that volunteers, special friends, and parents understand what they can expect. Please take a moment to read over and check the boxes below each guideline that establishes safety and promotes friendship based on mutual respect and personal well-being for everyone involved in our program. You may not be involved in a specific program referenced; however you may be involved at some point during the year so please acknowledge by checking every statement.

I understand that participation in this program is entirely voluntary and requires participants to abide by applicable rules and standards of conduct, to use their best judgment and sense of responsibility when volunteering in all program and events, and to serve as a role model to our special friends and other volunteers.

I agree

I understand that, as a result of being a Friendship Circle volunteer, I will be building bonds with special friends who will be counting on me to be present consistently. Volunteer Attendance must be a priority.

I agree

I understand that as a volunteer with this program, the use of a phone or other electronic devices during programs does not promote healthy friendships. A cell phone should only be used in case of emergency.

I agree

I understand that participation in Friendship Circle activities involves a certain degree of risk and can be physically, mentally, and emotionally demanding. I agree to take on this responsibility.

I agree

For the safety of all participants of the program, I agree to not use or posses any illegal substances, including during Friendship Circle programs or events.

I agree

For the safety of all participants of the program, I agree to not use or possess any illegal substances, including during Friendship Circle programs or events.

I agree

I agree not to bring any alcohol, tobacco products, weapons, firearms, or other dangerous items to any Friendship Circle program or events.

I agree

I understand that once I commit to attend an event, the FC staff and special friends expect me to fulfill my commitment. In the event that I am unable to volunteer during my scheduled time, I will contact the FC Coordinator at least 48 hours in advance, barring illness or family emergency.

I agree

I agree to respect the privacy of all participants of the Friendship Circle and to keep all personal information confidential.

I agree

If someone gets hurt or another type of incident occurs while I am volunteering at the Friendship Circle, it is my responsibility to immediately report the occurrence to a Friendship Circle staff member.

I agree

I agree to represent the Friendship Circle of Miami to the best of my abilities.

I agree

Please let me know which days you are available to volunteer.

Monday: 4:00-6:00 p.m.
Tuesday: 6:30-8:00 p.m.
Wednesday: 4:00-6:00 p.m.
Sunday: 1:30-4:30 p.m.

Young Adult Volunteer Application 23-24

Medical Information

Emergency Contacts

Code of Conduct

About Us

Volunteers

Events