Friendship Club

Do you have a child 8-12 years old who could be a great friend to another child with a disability?

Friendship Club is a great place to start!

Children in the Friendship Club attend FriendsTogether to befriend and celebrate their Judaism with other children who have a disability under teen and adult supervision. This is a great way to introduce your child to the importance of inclusion and disability awareness as well as prepare them to potentially become a teen volunteer for Friends@Home.

Please fill out the form below to enroll your child in the Friendship Club for the 2023-24 school year.

Child Information

Full Name*

How did you hear about us?*
FacebookInstagramGoogleReferral

Who told you about us?*

Why do you want to participate in Friendship Circle Northern Virginia?*

Congregation*

Please list some of your interests/hobbies*:

How would you like your child to participate in the Friendship Club?*
My child would be a great friend to another child with a disabilityMy child has a disability and would benefit from a friend

We create info cards with the following useful information for volunteers to have before meeting your child/teen so they can have the most fun possible!

Does your child/teen have any food allergies or restrictions?*

Does your child/teen have any medical conditions that may need to be addressed (Ex: insulin injections, history of seizures, etc.)?*

How much/what kind of help does your child/teen’s need in bathroom?*

Does your child/teens have any mobility constraints? If so, what are some methods used to aid your child?*

Does your child/teen have triggers such as topics of conversation to avoid, sensory triggers, etc.? If so, what are they?*

In the event that your child/teen is triggered, what are some effective calming techniques that can be used? Please include any behavior management reward systems or phrases that help your child/teen refocus.*

What methods does your child/teen use to communicate? Are there any helpful signs to know?*

What type of activities or part of our program do you think your child/teen will need assistance with? (Example: transitions, small motor, fine motor, large motor, etc...)*

Is there any other information that you wish to share with the FC volunteers?

Is there any other information you would like to share with the FC staff?

Date of Birth*

Street Address 1*

Street Address 2

City*

State*

Zipcode*

School*

Grade in 2023-24 School Year*

Parent Information

Mother's Full Name*

Email*

Mobile*

Occupation*

Father's Full Name*

Email*

Mobile*

Occupation*

I hereby give my son/daughter permission to participate in Friendship Club

I understand that my son's/daughter's participation in Friendship Club requires them to attend FriendsTogether

I understand that my son's/daughter's photograph may be taken and may be used for promotional purposes

I hereby release Friendship Circle, its providers, and administrators from ALL liability resulting from any incident which affects the health, welfare, or safety of my child while participating in a Friendship Circle program for the year 2022-2023.

I agree to subscribe to the monthly Friendship Circle Northern Virginia newsletter

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