Name
*
First
Last
Gender
*
Female
Male
Age
*
Please enter a number from
0
to
120
.
Email
*
Phone
*
Where do you currently live?
*
Baltimore
Chicago
Cleveland
Florida
Israel
New England
New Jersey
New York
Los Angeles
Toronto
Which category best describes you?
*
I am a registered Yachad Member
I used to be a Yachad Member but now do other things aside from Yachad
I sometimes attend Yachad programs as a participant but am not an official member
I am a member of another organization for individuals with developmental disabilities
I am a High School student in a Mainstream School
I am a mainstream peer at Yachad events or Yachad summer programs
I am an advisor at Yachad programs
I used to be a Yachad Advisor but am not actively involved in Yachad right now
I am an adult peer / friend of Yachad
Which school or organization are you part of?
*
Is there anyone in particular from Yachad you would like to connect with through this program?
*
No one in particular / I'm looking to meet someone new
Yes (please type the name of your request in the box below)
If yes, please provide us with their contact information.
*
What are your interests or hobbies?
*
If the opportunity arises, would you potentially be interested In participating with more than one buddy?
*
Yes
No
How did you hear about this program?
*
By submitting this form you grant permission to Yachad to share your contact information with your buddy.
*
I agree.