Online Volunteer Registration - Chabad of West Hempstead

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Online Volunteer Registration

Friendship Circle Volunteer Registration
All NEW and OLD Volunteers MUST fill out this Registration Form yearly.
Personal Information
Name*
First NameLast Name
Birthday*
MonthDayYear
Sign-Up Age*
School
Grade
Cell Phone #*
Area CodePhone Number
Home Phone #*
Area CodePhone Number
E-mail*
Please list any allergies.
*
I am a returning VolunteerI am a new Volunteer
Parent Information
Parent's Name (1)*
First NameLast Name
Parent's Cell Phone (1)*
Area CodePhone Number
Parent's Email Address (1)*
Parent's Name (2)
First NameLast Name
Parent's Cell Phone (2)
Area CodePhone Number
Extra Information
I am interested in:
Friends@Home WeeklyFriends@Holidays Monthly

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Volunteer PartnerYou can either list your continuing partner, or request who you'd like to partner with.
What day of the week is best for your volunteer schedule?
I will keep Friendship Circle Information confidential at all times.*
Yes, I agree.No, I disagree.
Signature*
Comments/Questions:
For any questions or concerns please contact the Coordinator at fc@chabadwesthempstead.org or Chaya Rochel at chayarochel@yahoo.com or (516)-592-2384.
Thank you!
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