Friends@Home Application

Untitled*

I would like to register my child to participate in Friends@Home
I would like to register to volunteer for Friends@Home

Participant or Volunteer Name*

First Last

Cell Phone*

Email*

Availability

Preferred Day of the Week (click all that apply)*

Preferred Time of Day (click all that apply)*

Mornings
Afternoons
Evenings

Preferred Meeting Format*

In-Person
Virtual
Hybrid

Volunteer Preference

Please select any preferences for volunteers that you would like us to consider when matching your child.

Gender*

Male
Female
No preference

Age*

12-15
16-18
No preference

Child Information

Please list any activities your child enjoys:*

How does your child manage frustration?

Additional helpful information about your child:

Volunteer Information

Do you have a friend interested in volunteering with you?*

Yes
No

Will your parent be driving you?*

Yes
No

What is the maximum travel time you're willing to drive for a Friends@Home visit?*

15 minutes or less
20 minutes or less
30 minutes or less
45 minutes or less

Please list any activities you enjoy.*

Parent Name*

First Last

Parent Phone*

Parent Email*

Consent

Background Check Consent

I have read and acknowledge the information below.

To help ensure the safety and well-being of everyone participating in the Friends@Home program, Friendship Circle requires a background check for all household members age 18 and older before a match can begin.

By checking this box, I acknowledge and agree that:

All household members age 18 and older must successfully complete a background check prior to participation in the program.
I am responsible for the cost of each background check, which is $25 per adult.
I understand that this is the only fee Friendship Circle passes on to participating families.
I understand that my child's match cannot begin until all required background checks have been completed and approved.

Parent/Guardian Consent*

I have read and understand the information below and give permission for my teen to participate in the Friends@Home program.

I understand that my teen will be volunteering for the Friends@Home program and may be visiting the home of a child, teen, or adult with a disability. I give permission for my teen to participate in the Friends@Home program.

Parent/Guardian Signature*

FRIENDS @ HOME

Availability

Volunteer Preference

Child Information

Volunteer Information

Consent