Ebchabad

Volunteer Registration

Name:

Birth date:

Grade:

Address:

City:

ZIP code:

Home phone:

Cell phone:

Email address:

School:

School phone number:

Father’s name:

Cell phone:

Mother’s name:

Cell phone:

Please list one reference (not a relative):

Name:

Relationship:

Phone:

When would you be able to visit your special friend?

1st choice:

Day of the week:

Time:

2nd Choice:

Day of the week:

Time

I give my teen permission to volunteer in the Friendship Club:

yes
no

I permit my child’s photos to be used for publicity purposes:

yes
no

Your initials as signature

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	Candle Lighting for Fri. May 25, 2012 in East Brunswick is: 6:56pm Shabbat ends at: 8:00pm Saturday, 19 May 2012. Yom Shabbat, 27 Iyyar 5772

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	Volunteer Registration Your Information Name: Birth date: Grade: Address: City: ZIP code: Home phone: Cell phone: Email address: School: School phone number: Father’s name: Cell phone: Mother’s name: Cell phone: Please list one reference (not a relative): Name: Relationship: Phone: Friends at Home When would you be able to visit your special friend? 1st choice: Day of the week: Time: 2nd Choice: Day of the week: Time Parental Consent I give my teen permission to volunteer in the Friendship Club: yes no I permit my child’s photos to be used for publicity purposes: yes no Your initials as signature
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