Today’s Date ___________________

BACKGROUND INFORMATION 

First Name      ___________________ Last Name__________________________

Local Address ___________________ City _______________________________

State ___________________ Zip ________________________________

Home Phone  ___________________ Cell Phone __________________________

Email ___________________ Emergency Contact  __________________

(EC) Phone ___________________ (EC) Relationship ____________________

Date of Birth ___________________ Birth Place __________________________

Do you use: (circle)

Email?   YES   NO FaceTIme?    YES NO   

Zoom?   YES   NO Whatsapp?    YES NO

Do you have grandchildren at this school? If yes, who?

____________________________________________________________________________

Do you have grandchildren in the area? If so, where? 

____________________________________________________________________________

What motivates you to become a grandfriend? 

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Please indicate the days and times during the week that you are available to volunteer: 

*Please note that this commitment requires a minimum of 2 hours per week. 

Monday_________ Tuesday_________ Wednesday___________ Thursday__________ Friday __________

What date are you available to begin? _____________________________________________

*Prior to your start date, we will need to complete necessary DCFS paperwork such as background check and medical.