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Home»Register»Participant Registration

Participant Registration

1Applicant
2Medical Info
3All About Me
4Parents
5Consent
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  • Participant's Info

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  • Important Info

  • Allergies

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  • Medications

  • Please list all prescription and non‐prescription medications the applicant will need administered during programs. Include the medication name, prescribing physician, physicians’ phone number, and the dosage instructions. When you check‐in at programs, please provide all medications (in their original packaging that identifies the prescribing physician (if prescription drug), the name of the medication, the dosage, and frequency of administration.
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  • Medical History

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  • All About Me!

    Important information that my volunteer needs to know.
  • Communication

  • Food

  • Behavior

  • Bathroom

  • Swimming

  • Parent/Guardian Info

  • Responsible Party's Info

  • Mother's Info
  • Father's Info
  • Guardian's Info
  • Other Parent's Info

  • Mother's Info
  • Father's Info
  • Other Guardian's Info
  • Signature

  • In-Person Protocol

  • COVID Procedures*
    I have reviewed and agree to the following procedures:
  • Parent/Guardian Signature Actions
     
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    Please read and sign the code of conduct
  • This field is for validation purposes and should be left unchanged.

Suicide Prevention Hotline:
1-800-231-11271

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Contact Info

10 Microlab Road
Livingston, NJ
07039-1602

973-251-0200
info@fcnj.com

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© Copyright - Friendship Circle New Jersey - Site by Click Consulting | Privacy Policy
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  • Participant Code of Conduct

  • As a parent or guardian of a participant at Friendship Circle:

    • I understand that Friendship Circle may match my child with a teenage volunteer.
    • I understand that it is necessary for me to assume full oversight and supervision responsibilities with respect to all activities Friendship Circle's assigned teen mentor(s) share(s) with my child in connection with his/her participation in the program.
    • I agree to respect the privacy of all participants of the Friendship Circle and to keep personal information confidential and will instruct my child to do the same.
    • If someone gets hurt or another incident occurs during a Friendship Circle program, it is my responsibility to immediately report the occurrence to Friendship Circle staff.
    • AS AN EXPRESS PRECONDITION OF MY CHILD’S ADMISSION INTO THE PROGRAM, THIS AGREEMENT MUST BE SIGNED AND SUBMITTED TO THE FRIENDSHIP CIRCLE. EXECUTION OF THIS FORM SERVES AS YOUR ACKNOWLEDGEMENT: (1) OF THE CRITICAL IMPORTANCE FRIENDSHIP CIRCLE PLACES ON YOUR AGREEMENT TO AT ALL TIMES HAVE AT LEAST ONE PARENT/GUARDIAN “ON PREMISES” DURING THE ENTIRETY OF EACH FRIENDS@HOME RELATED VISITATION; AND (2) THAT THE PARENT/GUARDIAN TAKES FULL RESPONSIBILITY FOR EVERYTHING THAT TRANSPIRES DURING THE VISIT AND EXEMPTS FRIENDSHIP CIRCLE FROM ANY RESPONSIBILITY OR LIABILITY;
    • ALTHOUGH FRIENDSHIP CIRCLE CARES DEEPLY ABOUT THE HEALTH AND WELL BEING OF ALL PARTICIPANTS, VOLUNTEERS, STAFF, AND THEIR FAMILIES, FRIENDSHIP CIRCLE CANNOT GUARANTEE THAT COVID-19 OR ANY OTHER VIRUS OR DISEASE WILL NOT BE CONTRACTED BY FRIENDSHIP CIRCLE PARTICIPANTS, THEIR FAMILIES OR STAFF
    • THE FAILURE TO ABIDE BY ANY OF THESE REQUIREMENTS MAY, IN THE EXERCISE OF FRIENDSHIP CIRCLE'S SOLE AND ABSOLUTE DISCRETION, RESULT IN THE TERMINATION OF ANY OR ALL FURTHER PROGRAM RELATED ACTIVITIES WITH YOUR CHILD.
    • I have carefully read and agree to abide and be bound by all the rules above and as well as any additional rules and policies pertinent to specific events, including the Commitment to Everyone’s Safety and Well Being.
    • I grant Friendship Circle permission to use my and my child’s name, image, likeness, or recording in connection with any promotional materials including, but not limited to, brochures, advertising, and broadcasts.
  • General Waiver

  • I give my child permission to participate in Friendship Circle. I understand that participation in Friendship Circle activities involves a certain degree of risk and can be physically, mentally, and emotionally demanding. I have carefully considered the risk involved and give consent for myself and/or my child to participate in this activity. I also understand that participation in this activity is entirely voluntary and requires participants to abide and be bound by all applicable rules and policies as set forth above and as well as any additional rules and policies pertinent to specific events, as it may be modified from time to time. I understand that this local Friendship Circle is independently owned, operated and controlled.

    I release LifeTown, Friendship Circle and Chabad of Livingston and its employees, directors, officers, contractors and volunteers from any and all claims or liability arising out of this participation.

  • Caregiver Waiver

  • My child regularly participates in Friendship Circle. In addition, if I also provide a nurse or other type of caregiver (“Caregiver”) for my child during LifeTown program(s). I agree to provide Friendship Circle with 24 hours’ notice or more in advance of each program that a new Caregiver will be accompanying my child. Additionally, I agree and fully comprehend that Friendship Circle cannot be held liable in any way for the conduct of said Caregiver or for anything arising out of the presence of the Caregiver in any way. I understand that this local Friendship Circle is independently owned, operated and controlled. I hereby release and agree to hold harmless and indemnify Friendship Circle and its employees, directors, officers, and volunteers, as well as its affiliates and all other organizations associated with Friendship Circle, from any and all claims or liability arising out of the participation of my child and their Caregiver.

  • Participant's Commitment to Everyone's Safety and Well-Being

  • Friendship Circle provides very special and unique opportunities for volunteers, special friends and their families to enrich the lives of each other. In doing so, most participants will encounter new and sometimes challenging situations. Thus, it is imperative to set expectations at the beginning so that volunteers, special friends, and parents understand what they can expect. Therefore, volunteers, special friends, and their respective families each certify and agree to the following by signing below that I:

    • Understand that participation in this activity is entirely voluntary and requires everyone to abide by applicable rules and standards of conduct;
    • Understand that photographs can be private and sensitive and should not be shared by all.
    • Do not use or possess any illegal drug, alcohol or controlled substances at any time, including at Friendship Circle events or programs;
    • Do not have any alcohol or tobacco products at Friendship Circle events or programs;
    • Do not bring any weapons, firearms or other dangerous items to any Friendship Circle event or program;
    • Do not have any unsecured firearms in a home which hosts a Friends at Home program;
    • Have not and do not have any individual that has been convicted of a crime, other than minor traffic violations, living at or visiting a home that hosts a Friends at Home program and have not themselves been convicted of a crime;
    • Do not have any individual that has a history of violence or abuse of any kind living at or visiting a home that hosts a Friends at Home program;
    • Agree to have a background check performed on me;
    • Understand that participation in Friendship Circle activities involves a certain degree of risk and can be physically, mentally, and emotionally demanding. I have carefully considered the risk involved and have given consent for me and/or my child to participate in this activity and knowingly and freely assume all such risks;
    • Will not participate in any activity that I believe I and/or my child cannot perform in accordance with the Friendship Circle activities’ instructions or in a safe manner;
    • If I observe any significant hazard during my or my child’s participation in any event or program, I will stop and/or have my child stop participating in the event and inform the Friendship Circle of such hazard immediately;
    • Agree to abide by and perform everything stated in the Handbook in its entirety.
    • Agree Friendship Circle is not responsible for any damages to personal property or injury in which the Friendship Circle had no knowledge of the particular hazard, or any activity outside of Friendship Circle sponsored events;
    • Acknowledge that Friendship Circle is an independently owned, operated and controlled local corporation.
    • Release Friendship Circle, the directors, board, officers, activity coordinators, and all employees, volunteers, related parties, and other organizations associated with the activity from any and all claims or liability arising out of this participation;
    • Agree that in case of emergency involving my child, I understand every effort will be made to contact me. In the event I cannot be reached, I hereby give my permission to the medical provider selected by the adult leader in charge to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for my child. Medical providers are authorized to disclose to the adult in charge examination findings, test results, and treatment provided for purposes of medical evaluation of the participant, follow-up and communication with the participant’s parents or guardian, and/or determination of the participant’s ability to continue in the program activities.
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