Printed from ChabadToledo.com

Participant Application

Participant Application

 Email

 

Child's Info
 

Child's Name

Birth Date

 /  /  
Month     Day        Year

Address

 

 

City

State      Zip 

Phone Number

 
Father's Info      

Name

Occupation

Cell Phone
   
E-Mail
   
 
     
Mother's Info
 
 
 
Name
Occupation
Cell Phone
   
E-Mail
   
 
 
Additional Info
Medical Info  

Emergency contact name 
(other than parent)

Phone
   

Cell


Please list any medical conditions that we should be aware of:
Please list any environmental, medicine or pet allergies: 
Please provide any information that may be helpful when interacting with your child:
 
 
Programs
Programs: Choose all programs for which you would like to participate  
                  View the 2013-14 Program Guide for Complete Schedule HERE

  
 Friends at Home           Info: Time & Day of the Week set up on an individual basis, see below

 Sunday Circle               Info: One Sunday a Month  1:00 - 3:00 PM See Program Guide for dates
 Holiday Circle               Info: Seasonal, See program Guide for Dates & Locations
 Bowling Buddies          Info: 6 Mondays, September 23 - October 28   4:45 - 5:45 PM
 Cooking Circle              Info: 4 Tuesdays, November 12 - December 9  4:45 - 5:45 PM
 Life Skills Events           Info: 4 Mondays, January 6 - February 10   4:45 - 5:45 PM
 After School Program   Info: 4 Tuesdays, March 11 - April 8    4:45 - 5:45 PM

 

If you chose Friends at Home, when would you like FC friends to come and visit your home?
 

1st choice  
Day of the week

Time

2nd choice  
Day of the week

Time


Would you be interested in having  the same volunteers   or   new volunteers
   
 

 
Code of Conduct & Consent form
In order for your child to participate in The Friendship Circle, the Code of Conduct
and Consent Form must be read completely and signed. 
 
  Download Code of Conduct and Safety Agreement HERE.  (2 Pages) 
  Then, return to this page to sign electronically. 

      I have read the Code of Conduct completely and agree to all of its contents.

      I have read the Safety Consent Form completely and agree to all of its contents. 
 

Signature        

Application Date          
 
 

 

 

 

 Email