2018-19 Registration

  • New York Friendship Circle Family Registration

    Program Year 2018-19
  • Participant Information

  • Parent's Information

  • Help us get to know your child




  • Programs

  • Which programs interest you?

  • Medical and Emergency Information

  • Medical Insurance

    This is for information purposes only. It will only be used in case of an emergency.
  • Friends at Home

    If you chose Friends at Home above, please fill out the following section. If not, you may scroll down to the Permissions portion of the form.
  • The Friends at Home program gives children the chance to spend time with their volunteers in an environment that they are most comfortable in: their own homes. The volunteers generally visit for 1 hour weekly.   Once we receive your form, our coordinator will find an appropriate match for your child. The time frame for finding a match depends on age, location, and flexibility. Keep in mind the more flexible you are, the easier it will be to find volunteers! 

    Please note, in order for us to get to know your child, and find an appropriate match among our volunteers, we request each Friends at Home applicant attend at least 3 Friendship Circle Events at the Chai Center before we can begin the Friends at Home pairing process. 

  • It is a pleasure to provide you with the Friends at Home service. However, it is necessary for the parents/guardians to assume responsibility to oversee and supervise activities shared together with your child. It is equally important to inform the Friendship Circle staff immediately with any concerns or issues that may occur. Please read the information below carefully and initial/sign your consent.

  • I agree that a parent/guardian will be at my home at all times while the Friendship Circle volunteers are interacting with my child; and such parent/guardian shall oversee and supervise all activities of my child and the volunteer.

  • I understand that this program does not provide tutoring, babysitting, therapeutic, referral, clinical, psychological, social or medical services. 

  • I understand that my teen volunteers are NOT permitted to drive or take my child to a location outside my home. If I wish to meet my volunteer at a different location, I may do so only:

              A. With my volunteers consent

              B. If I provide transportation to and from the location

              C. If I remain with my child and volunteers throughout the duration of the F @ H visit (If you are attending a Friendship Circle activity, you do not have to remain with your child and volunteer).

  • Family Information

  • Sibling Information

  • Permissions

  • I understand events may be lived streamed, video taped and/or photographed. Although my child’s likeness may appear digitally or in print media, their full name will not be used without my express permission. By submitting this form I agree to the policy regarding photographs and video tapes of events my child may be participating in.

  • I have read, agree to and signed the General Events Waiver (click here or find on the registration page) and will return the completed waiver prior to my child participating.

  • By signing below, I release the Friendship Circle, its providers, administrators and volunteers from any and all liability, damages, injuries or claims to property or persons for any incident, occurrence, or accident which may occur and which affects or involves the health, welfare, or safety of my child during the course of the provision of such service by a Friendship Circle volunteer, staff member or administrator.

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Ariella's NY Friendship Circle
501 Vanderbilt Parkway
Dix Hills, NY 11746
631-351-8672