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FRIENDSHIP CIRCLE

A Place To Connect & Belong

MEMBERSHIP FORM

A LITTLE ABOUT YOU

Welcome to Friendship Circle! We're so glad you're joining or catching back up with us.

BIrthday
Month
Day
Year
Single choice
Cellphone
Landline

JUST IN CASE

We likely will never need this, but its important to have on file — who should we call?

SUPPORT & ACCESSIBILITY

A few things that will help us help participants

Do you use any of these to get around?
Would you ever need a hand getting to and from our programs?

MEMBERSHIP

Please select one membership option below:
Please Include in my Membership
Is this a renewal or new membership?
New Member
Renewing Member

LAST STEP

A Few Things We Need to Ask

PHOTO & MEDIA RELEASE - We love celebrating our community! Occasionally we take photos or videos at programs to share in our newsletter, annual report, or on social media.
Yes, it's okay to use photos/videos of me for these purposes
No, please don't include me in photos or videos
EMERGENCY CONTACT CONSENT In the rare case of a medical emergency during a program, we want to be able to act quickly.
I give JCC SoCo permission to seek emergency medical care and contact emergency services on my behalf if needed, and to share relevant health information from this form with first responders.
PARTICIPATION & LIABILITY RELEASE - Friendship Circle programs may include physical activity, travel by bus or car, and time in public spaces.
I understand these activities carry some inherent risk, and I release JCC SoCo, its staff, and volunteers from liability for injury not caused by their negligence.

What's Next?

How Should We Reach You?
I would like a personal phone call from a Friendship Circle member to learn more about the program opportunities and/or to ask questions.
Yes
No
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