Volunteer Name* First Last Email* Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Birthday*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender*MaleFemaleSchool Name*One Reference (Name and Number)*Grade*6789101112CollegeParent's InformationParents must give permission for volunteers under the age of 18.Father's Name First Last Father's Email Father's PhoneFather's OccupationMother's Name First Last Mother's Email Mother's PhoneMother's OccupationPermission* I hereby give my son/daughter permission to participate in Friendship Circle programs * I hereby release the Friendship Circle, its providers and administrators, from ALL liability for any incident which affects the health, welfare, or safety of my child in the provision of a Friendship Circle program
