Personal InformationFull NameFirst NameLast NameBirth Date1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day2019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearAddressStreet AddressStreet Address Line 2CityState / ProvincePostal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNagorno-KarabakhNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandTurkish Republic of Northern CyprusNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTransnistria PridnestrovieTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOtherCountryE-mailHome PhoneArea CodePhone NumberCell PhoneArea CodePhone NumberPreferred PhoneHomeCellSchoolGrade2017-18Facebook IDParent's InformationMother's NameMother's Cell PhoneArea CodePhone NumberMother's EmailFather's NameFather's Cell PhoneArea CodePhone NumberFather's EmailReferenceReference NameRelationshipReference PhoneArea CodePhone NumberReference E-mailAdditional InformationEmergency Contact NameEmergency Contact PhoneArea CodePhone NumberEmergency Contact Cell PhoneArea CodePhone NumberAllergiesPlease list any allergies here:Medical ConditionsPlease list any medical conditions we should be aware of:Volunteer InterestsPlease choose the programs for which you are interested in volunteering.Complete program dates and times can be found on our 2017-18 Program Guide >> (Right click to open in new browser)Friends at HomeDay and time set up on an individual basisYesNoSunday CircleOne Sunday a month, 12:30 - 3:00 PMYesNoBowling Buddies7 Mondays in Oct/Nov, 4:45 - 5:45 PMYesNoArt Circle3 Tuesdays in December, 4:45 - 5:45 PMYesNoCooking Circle7 Tuesdays in Jan/Feb, 4:45 - 5:45 PMYesNoLife Skills3 Tuesdays in MarchYesNoSummer CampSun July 21 - Thursday, July 25, 2019YesNoOption 3Friends at Home - Day of WeekIf applicable, please tell us which day of the week you would like to do your home visits.Volunteer PartnerIf applicable, please tell us the name of a friend you would like to volunteer with.Do you drive or have rides?For Friends at Home visits and EventsYesNoPreferred Contact MethodFor events and reminders. Please choose all that apply.FacebookEmailCell PhoneTextHouse PhoneI understand that Community Service hours will be issued only for volunteering that is submitted on the Volunteer Hours form. SignatureCode of Conduct & Consent FormsIn order to volunteer for The Friendship Circle, the Code of Conduct and Safety Waiver must be downloaded and printed, read completely, and signed. If you are under 18 years of age, a parent or guardian must sign this form as well. Download Code of Conduct and Safety Agreement HERE. (Right click to open in new browser) Both must be printed and signed. You may bring them to the Volunteer Kickoff or mail them to the Friendship Circle office at 2728 King Rd, Toledo OH 43617Then, return to this page to sign that you have read and signed the above agreements. I have read the Code of Conduct and agree to all of its contentsI have read the Safety Waiver and agree to all of its contentsVolunteer SignatureIf applicant is under 18 years of age, the signature of a parent/guardian is required.Parent/Guardian SignatureDate of ApplicationMonthDayYear SubmitShould be Empty: This page uses TLS encryption to keep your data secure.