BBBS East TN Child Application

Hidden Fields
To look up the owner's email for notifications
For notifications
Youth Information
Enter a date in the following format: mm/dd/yyyy
This is the year the youth will graduate.
Guardian Information
Enter a date in the following format: mm/dd/yyyy
Type NA if unemployed
Family Information
Knoxville Office: Anderson, Blount, Knox, Sevier

Tri-Cities Office: Carter, Hawkins, Roane, Sullivan, Washington 
Physical Address
Existing Household Members
Please choose this child's relationship to the following people:

Are there any special health conditions? Please select all that apply. 
Press CTRL while choosing to select multiple
Emergency Contact
Parent/Guardian Agreement
Virtual Platform Agreement

Confidentiality Policy

Big Brothers Big Sisters of East Tennessee respects the confidentiality of client and volunteer records and, with the exception of situations listed below, shares information about clients and volunteers only among the agency professional staff.

All records are considered the property of the agency and not the agency workers or clients or volunteers themselves. Records are not available for review by the clients or volunteers.

1. Information will be released to other individuals or non-BBBS organizations only with the client or volunteer's written consent.

2. Identifying information regarding clients and volunteers may be used in agency publications or promotional materials unless the clients or volunteer request otherwise.

3. For purposes of program evaluation, audit, or accreditation, and with the prior approval of the Board of Directors, certain outside bodies such as Big Brothers Big Sisters of America may have access to client and volunteer records.

4. Members of the Board of Directors or evaluators appointed by the Board have access to client files upon authorization of the Board of Directors.

5. Information shall only be provided to law enforcement officials or the courts pursuant to a valid and enforceable subpoena.

6. Information shall be provided to an agency's legal counsel in the event litigation or potential litigation involving the agency.

7. State law mandates that suspected child abuse be reported to the Tennessee Department of Children's Services.

8. If an agency worker receives information indicating that a client or volunteer may be dangerous to himself or herself or to others, necessary steps may be taken to protect the appropriate party. This may include a medical referral or report to the local law enforcement authorities.

9. At the time a child or volunteer is considered as a match candidate, information is shared between the prospective match parties. The information about the volunteer may include such items as: age, sex, race, religion, interests, hobbies, marriage, family status, sexual orientation, living situation, etc. Information about the child may include such items as age, sex, race, religion, interests, hobbies, family situation, etc.

I agree to program participation under the above conditions. I further agree that I will not share identifying confidential information with anyone outside the agency, including family, friends, or community members, without the written consent of the persons involved (parent or guardian of a client or youth volunteer, or the adult volunteer). I also acknowledge that such information should be shared judiciously even within the ranks of Big Brothers Big Sisters, only with persons who have a specific need to know the information, and only in situations where others would not overhear such communication.

DISCLAIMER: I understand that this consent automatically expires 90 days after the closing date of this case at Big Brothers/Big Sisters of East Tennessee, Inc. unless an earlier date is specified. I am aware that this consent is subject to written revocation by me at anytime.