BSWYouth Application BSW

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Application

Non-Discrimination Policy
Our participants come to us with a wide range of personal characteristics.  Children are not excluded on the basis of race, religion, national origin, color, gender, sexual orientation, disability, gender identity, veteran status, or marital status of parent. 

Hidden Fields
To look up the owner's email for notifications
For notifications
Youth Information
Start typing name of school
This is the year the youth will graduate.
Press CTRL while choosing to select multiple
Guardian Information
Type NA if unemployed
Family Information
Physical Address
Our programming is free regardless of your income.
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Existing Household Members
Please choose this child's relationship to the following people:


Emergency Contact

In order for us to make a better informed match for your child, please answer the following:

Note: We will make every effort to honor your preferences for your child's mentor, but not all preferences can be guaranteed. BBBS does not discriminate on the basis of race, ethnicity, gender, marital status, sexual orientation, or religion.
Note: We will make every effort to honor your preferences for your child's mentor, but not all preferences can be guaranteed. BBBS does not discriminate on the basis of race, ethnicity, gender, marital status, sexual orientation, or religion.

Parent/Guardian Agreement

By signing below, I give permission:

 

1.      For my child to participate in the Big Brothers Big Sisters Beyond School Walls Program      

2.      For my child to be transported by a school district bus to the site location and back to their school; 

3.      For the school to provide social and academic information about my child to Big Brothers Big Sisters (e.g. report cards, attendance and behavior reports);

4.      To have my child participate in an enrollment interview conducted by Big Brothers Big Sisters staff and complete questionnaires throughout his/her time in the program containing questions about school, home life, and personal interests;

5.      To have my child talk with a Big Brothers Big Sisters staff person about personal safety;

6.      For BBBS staff to provide contact information to the volunteer for the purpose of contacting my child.

7.  To receive communication from Big Brothers Big Sisters of Central Carolinas staff via phone call, email and/or text (SMS) messages.

 

I understand that the program is not obligated to match my child with a volunteer and that as part of the enrollment process I may be asked to provide additional information. I understand that the information I provide in the enrollment process will be kept confidential, unless disclosure is required by law and with exceptions noted.  I understand that incidents of child abuse or neglect, past or present, must be reported to proper authorities. I understand that certain relevant information about my child will be discussed with the volunteer who is a prospective match (i.e. demographic information, information relevant to volunteer preferences, and information shared in my child’s in-take interview).

 

I certify that all of the information on this form is true and correct and that all income is reported.  I understand this information is being given for the receipt of federal funds, that the information on this application may be verified, and that deliberate misrepresentation of the information may subject me to prosecution under applicable state and federal laws. I understand this information will not affect my qualification for the program.

 

I do hereby release, waive, and hold harmless the organization and its employees, agents, members, volunteers and all other persons on its behalf from any and all liability for any damage or injury which such child might sustain while participating in said program and sponsored activities, including but not limited to any liability to any right of action that may occur to such child directly, or to me as his/her guardian. I understand that this information may be shared with the school or with partnership agencies when applicable.

 

If my child is matched with a Big Brother or Big Sister I agree to support my child’s match by reviewing the program and safety information given to me by Big Brothers Big Sisters, communicating with Big Brothers Big Sisters staff at least once per semester and once during summer break, and immediately reporting any concerns I might have to the school or Big Brothers Big Sisters staff. I also understand that my child’s relationship is considered site-based and will only occur at this time during the school year unless approved by Big Brothers Big Sisters beforehand.



I understand that by choosing no, my child may not be able to participate in the BBBS program.
Parental/Guardian Publicity Consent Form

Summer Contact

Virtual Meeting Platform Guidelines

Our goal at Big Brothers Big Sisters of Central Carolinas (BBBSCC) is to foster and protect the potential of youth in our region through impactful mentoring and activities.  We love it when our matches can meet in-person, but recognize maintaining meaningful connections sometimes requires the flexibility to meet through virtual means. 


As you are aware, there are potential dangers associated with internet-based communications. These dangers exist in many settings; however, we believe the benefits of virtual communications and virtual match activities in our Program outweigh the potential risks and we are taking appropriate precautions.


 

As the parent/guardian:

 

I give permission for my child to participate in virtual audio/video meetings (including but not limited to Zoom, Microsoft Teams, Google Meet, FaceTime) with BBBSCC staff, volunteer mentors, other youth mentees and other participants of the BBBSCC program.

 

I agree to ensure that my child has access to a smartphone, tablet, or laptop and internet access to join these meetings/activities. 


I acknowledge that BBBSCC will provide a link that can be opened in a web browser to access any sponsored match activities or match support check-in conversations.


I understand that any audio/video communication may involve two-way camera and audio usage and will work with my child to minimize any distractions during the virtual meetings and activities.


I agree to ensure that my child is mindful about what  family activities would potentially be heard/seen during their use of virtual meeting platforms.


I will ensure that my child knows to dress appropriately when using virtual platforms and makes sure there are no distracting materials or backgrounds.

 

I understand that mentors, youth and parents/guardians may not take photos, screenshots, or record video or audio from these sessions.

 

 I grant permission for my child to complete questionnaires including but not limited to questions about peer relationships, feelings about school, grades, educational expectations, parental relationships and attitudes toward risky behaviors.

 

I will maintain the confidentiality of other youth, if my child is participating in a group mentoring session or group match activity.

 

I understand that BBBSCC will not record any sessions when youth aged 12 years of age and under are present, but may take photos to share on social media or with partners.

 

I understand that BBBSCC may record sessions only when youth 13 years of age and over are present to share on social media or with partners.

I understand that by choosing no, my child may not be able to participate in the BBBS program.
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