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Chaverim Intake Form

Thank you for your interest in Chaverim – a vibrant and inclusive program at the JCC dedicated to building friendships, fostering community, going on adventures, trying new things and being independence. Chaverim, the Hebrew word for friends, perfectly captures the spirit of our group. We bring together adults of all ages and abilities weekly to enjoy meaningful social, recreational, and educational experiences. Through these shared moments, participants form lasting friendships, strengthen community bonds, and help raise awareness and visibility for adults living with disabilities.

To begin the process and help us get to know the prospective participant better, please take a few moments to complete the attached intake form.

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Email *
Name of Person Completing Intake Form *
First & Last
Name of Participant  *
Current Age of Participant *
Participant's birthday

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Participant Phone Number
Participant Email Address
Best way to contact participant *
Participant's Home Address  *
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