SB Youth Application and Permission

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Demographic Information

Youth's First Name

Youth's Last Name

Youth's Date of Birth

Youth's Gender

Youth's Preferred Pronouns

Youth's Racial Indicator

Other Race

Youth's Ethnicity

Please list allergies:

Any health considerations, or current medications your child has that might affect your child's participation in the program:

Does this child have siblings enrolled in Big Brothers Big Sisters?

If yes, what are those siblings' names?

Parent/Guardian First Name

Parent/Guardian Last Name

What is your relationship to this child?

Other Relationship

Street Address

City

State

Zip

County of Residence

Mobile Phone

Secondary Phone

Preferred Contact Method

Does the youth's primary guardian speak English?

What is the primary guardian's preferred language(s)?

Youth's School Information

Youth's School

School

Youth's Current Grade Level

(2024-2025)

Youth's HS Graduation Year (click here to accurately calculate grad year)

Was your youth eligible to receive Free/Reduced Lunch in the 2023 - 2024 school year?

Emergency Contact Information

Emergency Contact Full Name (If possible, please list someone other than yourself.)

Emergency Contact Relationship to Youth

Emergency Contact Phone Number

Planning and Support

Why would you like your child to have a mentor through Big Brothers Big Sisters?

What makes your child special?

What factors and qualities should we keep in mind when pairing your child with a mentor?

BBBSTS POLICIES AND PERMISSIONS

Program Participation Policy and Permissions

· I give permission for my child to participate in the BBBS Site Based Program for the duration of the match relationship. This could be more than one school year.

· I understand that the BBBS agency is not obligated to pair my child with a volunteer. As part of the enrollment process, my child may be asked questions around their understanding of personal safety, academics, overall well being, and thoughts of their future.

· I authorize BBBS to communicate with school staff to help support them in the program.

· If my child is paired with a mentor, I agree to talk to my child about their BBBS experience and immediately report any concerns I might have to BBBS staff.

· I have reviewed and understand the program expectations outlined in the attached program summary specific to my child’s school.

· I agree to reach out with any questions, concerns, or feedback and partner with BBBS in this mentoring experience for my child.

Photo/Video Permission
We want everyone to feel safe and comfortable. You give our team permission to capture special moments (quotes, stories, photos and videos) to share the amazing work we do together with Littles, their families, Bigs and our community - whether it's through our publications, website, or social media, or with our donors, funders and community partners. Your privacy is important to us, and we're here to make sure you enjoy the program in the way that feels best for you.

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Contact Information