Family Reference FormFriendship Circle provides social opportunities to children and teens with special needs, involving them in a full range of social and Jewish-inspired programs. We strive to create genuine friendships which empower and enrich the lives of everyone involved; there’s nothing like spending time with a true friend. Our Friends@Home program is a weekly play date during which a typically-developing teen visits the home of their Special Friend to hang out and have fun together. We our dedicated to the safety of all of our friends and make every, effort to ensure that everyone feels comfortable. The information you provide will help us in accepting and introducing appropriate friends to each other. Confirmation* I understand that this form must be completed by a non-relative and that all information provided will be held in confidence.Name of Reference* TitleMr.Mrs.MissMs.Dr.Prof.RabbiRev. Prefix First Last Reference Phone*Reference Email* Relationship to Special Friend's family*Name of Special Friend's Parent* First Last The parent(s) is/are very reliable. They are to make scheduled commitments and consistently follow through.*Strongly agreeAgreeDon't KnowDisagreeStrongly disagreeI feel that the parent(s) has/have a healthy amount of authority in their home*Strongly agreeAgreeDon't KnowDisagreeStrongly disagreeI would feel comfortable allowing my teen to spend hour-long visits in this family's home, even if I wasn't present.*Strongly agreeAgreeDon't KnowDisagreeStrongly disagreeThe parent(s) are very caring but seem somewhat over-protective and overbearing.*Strongly agreeAgreeDon't KnowDisagreeStrongly disagreeI think the parent(s) would appreciate this opportunity and give their child the chance to spend time playing with their Teen Friend*Strongly agreeAgreeDon't KnowDisagreeStrongly disagreeIs there any important information about this family that you feel we should know? (Confidentiality will be maintained)Signature*Use your mouse, stylus, or finger to sign in the box below. To erase, click the circle in the corner below the box.Date* MM slash DD slash YYYY Δ
