JUST FRIENDS REQUEST APPLICATION
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here to download this application in Microsoft Word format
It is
better for filling out and printing this
application,
Please print. If you need help answering some of these
questions, please ask someone to help you.
Name
_____________________________________________Age__________________
Address
________________________________________________________________
Phone (H)________________________________
(W)___________________________
Best time to call
__________________________________________________________
Emergency contact ____________________________________ Phone
______________
Insurance ______________________________________Policy
#___________________
Legal guardian/parent (if applicable)
__________________________________________
Relationship ___________________________________Phone
_____________________
Address_________________________________________________________________
How would you describe your disability?
Do you need special accommodations? (wheelchair, interpreter)
Do you have any physical/medical concerns for which you see a
specialist or for which you take medications?
What kind of transportation can you use to meet your Volunteer
Friend?
Describe yourself and what you like to do? (Use the back of
this page if you need more room)
What do you think makes a person a good Volunteer Friend?
What do you think makes you a good Friend?
Tell why you would like to have a Volunteer Friend.
What are good times for you to go out with your Volunteer Friend?
What are some things you would like for your Volunteer Friend to
know about you? (If you have a job or special hobbies might be good
information to include)
Please sign your name here if it is all right to share this
information with your Friend Match
Signature:
________________________________________________________Date_________
Parent/Guardian (if applicable)________________________Date_________
Please sign your name here if it is all right to have your picture
taken or have a video made with your Volunteer Friend to be used
for promotional purposes (To let people know about the Friend
Program).
Name: ___________________________________________Date__________
Parent/Guardian (if
applicable)________________________Date__________
Please return to:
The Arc of SC
Community Just Friends Program
1823 Gadsden Street
Columbia, South Carolina 29201
Applications may also be faxed to (803) 779-0017.