2016 Friendship Circle Volunteer Registration Form Personal Info Volunteer's Info Name Birth Date / / Month Day Year Address City State Phone Number Zip Email Date of Bar/Bat Mitzvah (7th & 8th Graders Only) / / Month Day Year School Grade ('12-'13) Email address Cell Number Cell Carrier Parent's Info Father's Name Occupation (Optional) Cell Phone E-Mail Mother's Name Occupation (Optional) Cell Phone E-Mail Temple Affiliation I understand that Community Service forms will ONLY be issued for volunteering that is recorded on the FC Honors program on a monthly basis. Please type your Signature: Additional Info Medical Info Emergency Contact Name (other than parent) Phone Cell Please list any allergies Please list any medical conditions that we should be aware of Please select the grade you are entering this coming year: 7th Grade 8th Grade High School College This page uses 128 bit SSL encryption to keep your data secure.