Big Brothers Big Sisters: Enroll a Youth

Guardian Information






Emergency Contact




Child Information




In order to enroll a child into our program, you must be a legal guardian of the child.







use format: mm/dd/yyyy
We collect demographic information for several reasons. The first is to ensure we're giving you and your child the best experience by honoring preferences and making thoughtful matches based on shared life experiences when possible. The second reason is our funders often require us to report this information in aggregate, meaning your child won't be identified individually.

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Address

Dirección del niño/a




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Program Policies

Media Release
I hereby authorize Big Brothers Big Sisters of Puget Sound to use my or my child’s image, voice and/or performance to promote the Big Brothers Big Sisters program.  I agree that there will be no compensation whatsoever for this participation or for the use of resulting materials by Big Brothers Big Sisters. I further agree that this participation confers no ownership rights.  Big Brothers Big Sisters of Puget Sound releases me from all liabilities or claims that may result from the existence and use of any such materials. 

Accident Policy

In the event that a Little Brother/Little Sister is involved in some type of accident involving an injury during a match activity, Big Brothers Big Sisters of Puget Sound has an excess accident policy, which may provide certain benefits.  Benefits payable are determined by the following information.

1.) If the injured is currently covered through a separate health insurance policy, that policy will act as primary insurance.  The excess accident policy provided by Big Brothers Big Sisters will act as a secondary insurance.  This means that the injured will have to submit the claim to his/her own insurance company prior to submitting a claim to Big Brothers Big Sisters accident insurance.

2.)  If the injured party is not currently covered by any other health insurance policy, the excess accident policy provided by Big Brothers Big Sisters will act as primary insurance.  A claim may be submitted directly to the accident insurance company and will be subject to a $25 deductible.

The maximum medical expense amount $25,000 with a $25 deductible for primary medical claims, and a $250 per tooth deductible up to a maximum benefit of $500 for injuries requiring dental work. I acknowledge that I have read and understand the accident policy outlined.


Parent & Safety Training

I acknowledge that I am responsible for the information contained in the Parent/Guardian orientation guide and do hereby agree to follow all of the guidelines outlined.

 

I acknowledge that my child and I will participate and complete the Safety Awareness Training with a member of the Big Brothers Big Sisters of Puget Sound staff.  I further acknowledge my role in protecting my child from abuse as discussed in the training.


Permission to Contact Providers

In some circumstances BBBSPS may use third party community partners to help in serving your child. We may share information you have provided us with these service providers, but remain committed to maintaining the confidentiality and security of your information. Accordingly, we will take reasonable precautions to ensure that there will be no unauthorized release of your confidential information to others.

The Big Brothers Big Sisters’ program model is evidence-based and well-researched. We utilize surveys as a way to determine our program’s success. You and your child will be asked to complete a few surveys while participating in our program. You and your child have the right to decline participation in surveys. From time to time Big Brothers Big Sisters contracts with third party evaluators and in such situations your child’s outcome data will be shared with the use of identifying information such as name and contact information. Confidentiality will be strictly maintained in such situations.

 

Part of BBBSPS’s mission is to help children be successful in school and refrain from activity that would lead to involvement in the juvenile justice system. BBBSPS will ask for an additional signed Release of Information to access any data from school districts (including grades and attendance records) and other youth-serving organizations to provide the best possible support to your family.  My signature below authorizes the school district and any other youth-serving organizations they are involved in to provide information to BBBSPS about my child when an additional release is signed and if such information will be needed to assist the agency in providing the best possible services to my child.  


Parent/Guardian Consent
I understand that BBBSPS is not obligated to match my child in the program and that it may be for any number of reasons that it is not considered a good fit.  I understand that BBBSPS is not liable to give reasons of non-acceptance. I understand and agree that for the duration of my child’s involvement with Big Brothers Big Sisters of Puget Sound any information that I or my child share with a staff member about personal, health, family or other may be shared at the discretion of the agency staff with potential mentor and with the mentor finally selected for my child, unless I specifically request otherwise.  I further understand that each staff member and mentor has agreed to abide by the confidentiality practices established by the agency.  I also understand that BBBSPS is not required to release files on my child to myself or any other party unless required by law but may share content with parties for whom we have a signed release at the agency’s discretion.

BBBS uses technology tools to enhance personal relationships. Our online platform allows volunteers, youth, parents and BBBS to connect securely using a web application. I understand that I and my child(ren) will be enrolled in BBBS' online communication platform as an option of communicating with my child's mentor and BBBS staff.  If I do not want my child to be connected to this online platform I will inform BBBS staff.


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