By
signing below, I give permission:
- For
my child to participate in the Big Brothers Big Sisters (BBBS)
School/Site-Based Mentoring Program (meeting in person for virtually;
- For the volunteer matched with
my child, who has been screened and approved by Big Brothers Big Sisters, to
personally interact with my child;
- To have my child participate
in an intake interview conducted by Big Brothers Big Sisters staff and complete
questionnaires throughout their time in the program containing questions about
school, home life, the match, and personal interests to evaluate and improve
program services;
- To have my child talk with a
Big Brothers Big Sisters staff person about personal safety;
- For BBBS staff to provide
contact information for me and my child to the volunteer;
- For
Big Brothers Big Sisters of Central MN and my child’s school/site to share and
exchange social, family and academic (e.g. report cards, attendance reports,
behavior reports) information about my child. Information will be shared on an
ongoing basis with staff in participating programs to monitor your child’s
progress. All information Big Brothers Big Sisters obtains regarding your child
and their participation in our program is confidential.
Big Brothers Big Sisters of Central MN
utilizes text messages to communicate with participants in our program. At any time, you wish not to receive these
texts please reply STOP. You will not receive any texts from us after that. Reply
HELP for help.
- For
my youth to communicate with their Big and the Big Brothers Big Sisters Program
Coordinator in person, over the phone, using the BBBS communication platform,
using other virtual technology, using mail, and/or via email.
I understand there will be no in-person
contact between my child and the mentor outside of the school/site setting
except for planned, supervised group activities provided by Big Brothers Big
Sisters. The Big is not allowed to babysit
for my family.
I understand that the program is not obligated to
match my child with a volunteer and that as part of the enrollment process, I
will be asked to provide additional information through an in-person interview.
I understand that the information I provide in the enrollment process will be
kept confidential, unless disclosure is required by law. I understand that incidents of child abuse or
neglect, past or present, will 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 relevant to child-safety and
well-being).
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, on behalf of myself and my child, completely
release and forever discharge Big Brothers Big Sisters of Central MN and its
employees, agents, members, volunteers and all other persons on its behalf,
together with any successors in interest, heirs, attorneys, agents,
representatives, and all persons acting by, through, under, or in concert with
them from all known and unknown charges, complaints, claims, grievances,
liabilities, obligations, promises, controversies, damages, actions, causes of
action, suits, rights, demands, costs, losses, debts, penalties, fees, wages,
attorneys’ fees and costs, and punitive damages of any kind or nature
whatsoever, whether known or unknown, which I may have, or may have had,
against Big Brothers Big Sisters of Central MN arising from any participation
in said program and activities, including but not limited to any liability to
any right of action that may occur to such child directly, or to me as their
guardian. I intend and understand that this release and discharge is to
be interpreted and enforced so as to provide the broadest release and discharge
possible as may be permitted by
law. 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 as outlined in expectations (which includes communication
at least once a month in the first year of the match), and immediately
reporting any concerns I might have to Big Brothers Big Sisters staff.
For your youth to have the best experience possible,
at the beginning of each school year Big Brothers Big Sisters staff will
automatically continue the match from the previous year or match your youth
with a new mentor. Each year we will attempt to contact you to verify the
information on your child’s application is current and to obtain permission for
your child to continue in our program. If we are unable to contact you, we will
continue on with the matching process. If at any time you wish for your youth
to discontinue the mentoring program, or your youth has changed schools and you
would like them to continue their match, please contact the Program Coordinator
at 320-253-1616.