24'-25' MVP Application

BS"D
MVP Program Volunteer Application
The Mitzvah Volunteer Program is a four-week orientation program for boys and girls that teaches our volunteers how to interact with children who have special needs. Volunteers will learn about various disabilities, appropriate conduct when volunteering, the importance of giving back to the community, and the huge impact they can make on others.

Please note: This application is only applicable for the MVP program and is not valid for volunteering at other FCLA programs.
Time: 7:00pm-8:00pm (MVP Fairs are held on Sundays)

Location: Friendship Circle of LA

1952 S. Robertson Blvd.

Los Angeles, CA 90034

Dates:

SESSION #1:

2024: November 14, November 21, December 5, December 12

MVP Fair for Session #1: Sunday, Dec 15, 2025

SESSION #2:

2025: Feb 13, Feb 20, Feb 27, Mar 6

MVP Fair for Session #2: Sunday, March 9, 2025

SESSION #3:

2025: April 29, May 6, May 13, May 27

MVP Fair for Session #3: Sunday, June 8, 2025
Volunteer Information
Please choose which session you would like to attend*

SESSION #1SESSION # 2SESSION # 3
Full Name*

PrefixFirst NameLast Name
Hebrew Name
Your Jewish Name
Gender*

MaleFemale
Date of Birth*

MonthDayYear
Date
Hebrew Birthday Month
Hebrew Birthday Day of Month
Volunteer Mobile Phone*
Home Phone*
Volunteer Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
School Attending*
Are you/your family affiliated with a synagogue?*

YesNoSometimes
If yes, which Synagogue?
List any/all Youth Groups with which you are affiliated*
If none, enter "None"
Grade (as of September 1, 2024):*

6th Grade7th Grade8th Grade
Parent/Guardian Status*
Volunteer Lives With:*
If this will be your Bar/Bat Mitzvah project, what date will you be having your Bar/Bat Mitzvah?
Parents/Guardian Information
Mother's Name*

PrefixFirst NameLast Name
Mother's Hebrew Name
Mother's Mobile Phone
Mother's Email*
example@example.com
Mother's Occupation
Mother's Place of Employment
Mother's Work Phone
Father's Name*

PrefixFirst NameLast Name
Father's Hebrew Name
Father's Mobile Phone*
Father's Email*
example@example.com
Father's Occupation
Father's Place of Employment
Father's Work Phone
Accident & Trip Declaration
Accident: As the parent/legal guardian of {fullname3}, I authorize any adult acting on behalf of Friendship Circle Los Angeles to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Friendship Circle personnel will try, but are not required, to communicate with me prior to such treatment.

Trips and Outings: I hereby give permission for my child/self, {fullName3}to attend and participate in all trips and outings organized as part of the program by Friendship Circle.
ACCIDENT & TRIP DECLARATION Parent/Guardian Signature*

Clear
Print Name
Date
Parental Consent
- I hereby give permission for my child to attend and participate in the MVP program and volunteering experience at Friendship Circle.
- I grant the Friendship Circle permission to use my or my child's name, image, likeness or recording in connection with any promotional materials including, but not limited to, brochures, advertising, social media and broadcasts.
PARENTAL CONSENT Parent/Guardian Signature*

Clear
Print Name
Date
Participant Name (full legal name):*
References (Required)
We require a reference form to be submitted for your application to be complete. It can be a Rabbi, teacher, or someone that is familiar with how you work with children. Simply direct them to the link below, or print the form for them and email them to us.

MAY NOT BE FILLED OUT BY A RELATIVE

Reference Form
Email for receiving receipts and confirmation of this application:*
example@example.com
Should be Empty:

MVP Program Volunteer Application

Volunteer Information

Parents/Guardian Information

Accident & Trip Declaration

Parental Consent

References (Required)