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2021-22 Application Form

  • Personal Information

  • Additional Information

  • Medical Information

  • Parental Consent

    (18 years old and younger)
  • I give my teen permission to volunteer in The New York Friendship Circle @ The Chai Center.

  • I understand that Friendship Circle events may be live streamed and photos may be taken. I understand my child’s likeness may be used in print or digital media with no names. Names will not be used unless unless express permission is given to use my or my child’s name.

  • Volunteer Agreement

  • I understand my commitement to the Friendship Circle programs and will honor my responsibility. 

    I agree to keep all information about my circle friend/s and their family/ies confidential.

    I understand that consistency is needed to form friendships. If I sign up for a weekly program, I will do my best to attend all scheduled program dates within the session for which I have signed up. If I can not attend it is my responsibility to contact the office immediately and find another volunteer to take my place.

    If I have signed up for Friends at Home and can not make my scheduled visit any week, I will call my friend and find another day to have our scheduled visit.

    Upon receiving email or text correspondence from the Friendship Circle, I commit to respond within 48 hours.

  • I agree to a one time-Community Service Due/Fee of $25.

    This fee will help support our 2021-2022 programs to make them as amazing and special as possible. That being said, we want our programs to remain accessible to everyone. If you have any questions or concerns, please contact [email protected]nyfriendshipcircle.com.


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