I choose to apply to be a volunteer for Big Brothers Big Sisters of Palm Beach and Martin Counties.  For this reason, I give the following permission to the agency:

I do hereby authorize representatives of Big Brothers Big Sisters of Palm Beach and Martin Counties to seek and obtain any information regarding myself deemed necessary by them, to provide quality, safe services to children in their programs.  This authorization includes requesting or releasing confidential information from/to the following individuals or agencies:  schools, social services, organizations, therapists, physicians, government agencies.

I understand that this will be considered confidential; and will not be released to other individuals or organizations without my specific consent.  I am aware that this consent will expire when my volunteer work is formally terminated with the agency.  I am also aware that this consent may be revoked by me at any time. My signature indicates that I know what information will be disclosed and the purpose for which it will be used.  My signature also means I have read this form or had it read to me and explained in language I can understand.

I agree and consent to the use of profile information in such form and manner as deemed appropriate by Big Brothers Big Sisters of Palm Beach and Martin Counties for recruitment and development purposes.

I hereby release, remise and forever discharge Big Brothers Big Sisters of Palm Beach and Martin Counties, its officers, and employees, successors and assigns from any and all rights of action, liability, demands or claims accruing or to accrue out of this use or resulting from any rights of action, liability, demands or claims relating to libel, slander or invasion of the right of privacy.

The references and youth organizations that I have worked for or been involved with as a volunteer whose information I have provided may be contacted by telephone or email.

I am in no way obligated to perform any volunteer services.

I hereby authorize Big Brothers Big Sisters of Palm Beach and Martin Counties to secure information it deems necessary from the following sources: medical records, employers, educational institutions, the military, criminal records, National and State Sexual Offenders and Predators Check, and any other pertinent sources to evaluate my potential as a volunteer. Continued involvement will be based on the information discovered.

Big Brothers Big Sisters of Palm Beach and Martin Counties has the right to accept or deny program participants and is not obligated to match me with a youth. Big Brothers Big Sisters is not required to provide me with a reason if I am not accepted or matched with a youth.

A.   A.  In order for Big Brothers Big Sisters of Palm Beach and Martin Counties to provide a responsible and professional service, volunteers, children and parents or guardians will be asked to divulge personal information about themselves. The agency respects the confidentiality of client and volunteer records and with the exception of the situations listed below, shares information only among the agency professional staff.

1.       For the purpose of program evaluation, audit, or accreditation, certain outside bodies such as Big Brothers Big Sisters of America and grantors, i.e. Children’s Service Council of Martin County, may have access to client or volunteer records.

2.       Members of the Board of Directors may have limited and specific access to client files only upon authorization by formal motion of the Board of Directors.

3.       Information shall only be provided to law enforcement officials or the courts if subpoenaed.

4.       Information shall be provided to the agency’s legal counsel in the event of litigation involving the agency.

5.       Suspected child abuse will be reported to the appropriate authorities.

6.       If any agency worker receives information indicating that a client or volunteer may be dangerous to himself or others, steps may be taken to protect the appropriate parties.

B.   All records are considered the property of the agency.

C.   Records are not available for review by clients or volunteers.

 Prohibited Activities:

• Overnight Visits
• Use of Alcohol and Illicit Drugs
• Non Disclosure of Firearms at enrollment and throughout the life of the match(see Policies/Procedure[i])
• Non Disclosure of suspected Child Abuse/Neglect  (see Reporting Policy/   Procedure [ii] )

• Transportation
• Safety Belts
• Florida law requires the use of seat belts or child restraint devices by drivers of motor vehicles, all front seat passengers and all children riding in a vehicle under 18.
• Florida’s safety belt law is a primary enforcement law, meaning that an officer can stop a vehicle and issue a citation simply for observing a safety belt or restraint violation.
• Children should be in the rear seats until at least age 12, since deployed front seat air bags can be dangerous to children.
• Child Restraints – Car Seats and Booster Seats
• Florida law requires children age 5 and under to be secured properly in a crash-tested, federally approved child restraint device.
• Children ages 0 to 3 must be in child restraint devices of a separate carrier or a vehicle manufacturer’s integrated child seat.
• Children age 4 and 5 must be in a separate carrier, integrated child seat or booster seat.
• The best child seat is one that fits the child, fits your car and that drivers will use correctly every time.
• Read the car seat’s instruction manual and the portion of your vehicle’s owner manual when you install a car seat.
• Remember to check for car seat and booster seat recalls.

o   School-based & School to Work mentors are prohibited from transporting children.

o   Only assigned and approved Big should transport Little.

• Firearms are prohibited in any vehicle that is transporting a Little

• Communication/Parental Approval of all activities
• Parents/Guardians will be informed and approve all activities in advance.
• Communication should be open at all times between match parties and agency staff (children should never be asked to keep a secret).
• Respect for all match parties will be demonstrated at all times.
• Emergency contact information will be provided and exchanged between match parties and agency staff.

• Limit Setting through Positive Reinforcement
• Positive limit setting strategies will be outlined based upon the age of the child and any developmental concerns (i.e. ADHD, Special Needs, etc.)
• Corporal punishment, verbally and/or emotionally abusive means of discipline by Bigs is strictly prohibited and will result in match termination and/or possible reporting of suspected abuse to Florida’s Child Abuse Hotline – if deemed appropriate.
• Preventing Over-Involvement with the Child and/ or the Child's family
• Gift Buying should be approved in advance by the parent/guardian and agency staff notified when a gift of an excessive nature is given to a child.
• Monetary donations or donations for services by the Big to the child’s family should be discussed and approved by the agency’s match support staff in advance.
• Excessive contact over the agreed upon schedule should be discussed with the agency staff (especially critical in the early stages of a match relationship).
• Involvement of other children on outings should be discussed in advance with the child’s parent/guardian and agency staff.

• Interactions between volunteers and children will show respect for privacy and personal boundaries.
• Children have the right to feel safe at all times.  Appropriate and positive interactions between Bigs and Littles are essential in supporting positive youth development and making youth feel valued.  Conversely, inappropriate or harmful interactions can potentially injure a child physically and/or emotionally.  Maintaining a balanced approach to development and monitoring of the match to ensure adherence to agency ground rules in this area is critical to positive youth development and child safety. 
• Volunteer will refrain from activities that pose a risk for injury.

• Agency ground rules surrounding volunteer and child interactions support strategies that help children establish a clear set of personal safety boundaries promoting skill-building that may prevent the child from becoming the victim of violence and/or exploitation (bullying, child sexual abuse, internet exploitation, dating violence, etc.) and/or encourage a child to disclose abuse or victimization.

• Volunteers are encouraged to be sensitive to whether a hug or other form of physical touch would be comfortable to a child or not. School-Based Mentoring must abide by the Code of Conduct of the Palm Beach and Martin Counties School Districts. 
• Certain types of physical contact such as: tickling, wrestling, pinching, patting, or asking a child to sit on an adult’s lap are more likely to violate a child’s personal boundaries. 
• Display or discussion of any materials of a sexual nature is strictly prohibited.
• Volunteers need to provide separate, private areas for a child to: change clothes, bathe, shower and/or nap.
• Volunteers should never sleep or nap with a child in the same bed, sleeping bag or couch.
• Volunteers should never come between a parent and their child. Volunteers need to respect a parent’s role and authority.

Weapons, firearms and ammunition will be made inaccessible at all times to a child while in the Volunteer Big’s care.

Firearms in the home

A)   As a matter of personal safety for the children we serve, all firearms and weapons must be locked and secured whenever the “Little” is in the home.

Firearms in a vehicle

A)   As a matter of personal safety for the children we serve, all firearms and weapons are strictly prohibited in any vehicle that is being used to transport a “Little”.

Any weapons, firearms or ammunition ownership are licensed, permitted, registered, and handled in accordance with all applicable state and federal laws

As a Mentor participating in Big Brothers Big Sisters of Palm Beach & Martin Counties, I agree to strictly comply with the above policies in order to ensure the safety of the children served.