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

School

Youth's Current Grade Level

(2025-2026)

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 understand that:

BBBS is not obligated to pair my child with a volunteer. As part of the enrollment process, my child will be asked questions about their understanding of personal safety, academics, overall well-being, and interest in participating in the program.
BBBS asks for a minimum commitment of one school year for a mentoring relationship, though it could last longer.
My child may occasionally spend lunch or recess with their mentor, approximately 2–4 times per month, as an alternative to their regular lunch or recess time.
BBBS will communicate with school staff to help support my child in the program.
It is important to follow the program expectations outlined in the attached program summary specific to my child’s school.
I can 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