CHILD APPLICATION
(
*
designates required fields)
PROGRAMS OF INTEREST
(You can check as many as you'd like):
FRIENDS AT HOME SUNDAY CIRCLE HOLIDAY PROGRAMS
TWEEN MUSIC CIRCLE
For those who checked box "FRIENDS AT HOME"
1) When would you like a volunteer to come to you home?
FIRST CHOICE:
SECOND CHOICE:
2) What does your child enjoy doing most?
3) Is there anything in particular that your child does not like doing?
4) Is there anything we need to know about your child?
5) Have you been to a VFC program? YES NO
If YES, which one?
6) How'd you hear about the VALLEY FRIENDSHIP CIRCLE?
QUESTIONS OR COMMENTS:
MEDICAL EMERGENCIES
D. Food allergies:
E. Additional medical information or comments:
I permit my child's photos to be used for publicity purposes to assist the Valley Friendship Circle.
Parent/Guardian’s
Signature: Date: