Printed from FriendsCleveland.com

FC Porch Visits

  • Friendship Circle is strictly adhering to the CDC guidelines and taking all precautions to ensure a safe environment for the participants and volunteers.
    Every client is now expected to complete the health history form below.

    We appreciate your cooperation during this time of the pandemic (COVID-19).

  • Pick a Date
  • Waiver and Acknowledgement:

    The family of the participant understands that at the time of the visit with Friendship Circle’s Volunteer(s) at least one parent will be present in the home for the duration of the visit.

    I, as well as all household members, do not currently have, nor have experienced the following symptoms including: a temperature greater than 100*, dry cough, difficulty breathing, fatigue, upset stomach, or sore throat within the last 14 days.

     ·         I affirm that I, as well as all household members, have not been diagnosed with COVID-19 within the past 14 days.

    ·         I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 within the past 14 days.

    ·         I affirm that I, as well as all household members, have not traveled outside of the country or to any city considered to be a "hot spot" for COVID-19 infections within the past 14 days.

    ·         I understand that Friendship Circle of Cleveland, its volunteers cannot be held liable for any exposure to the COVID-19 virus caused by misinformation on this form or the health history provided by each visitor.

    • Face Covering Protocol
      • Volunteers are required to wear a face mask
      • Participants are required to wear a face mask (if manageable)

    ·         Volunteers and participants are keeping a social distance of 6 feet apart

    ·         Wash hands / sanitize frequently.

    By entering my initials below, I agree to each statement above and release Friendship Circle of Cleveland from any and all liability for unintentional exposure or harm due to COVID-19.

    By entering my initials below, I further agree to adhere to the following guidelines per each visit of Friendship Circle Teens to my home. In the event that any of the above mentioned occurs I will notify the Teens not to come for a visit, and will notify a Friendship Circle staff member as well.

  • Should be Empty: