Youth Application

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Non-Discrimination Policy
Our participants come to us with a wide range of personal characteristics. We believe that participant eligibility shall be determined without regard to race, color, religion, national origin, age, gender, marital status, sexual orientation, gender identity and expression, veteran status, disability, familial status, pregnancy, genetic information, or any other characteristic protected under applicable federal, state, or local laws.
Hidden Fields
To look up the owner's email for notifications
For notifications
Youth Information
MM/DD/YYYY
This is the year the youth will graduate.
Guardian Information
Type NA if unemployed
Family Information
Physical Address
Emergency Contact

Additional Questions

Existing Household Members
Please choose this child's relationship to the following people:


Parent/Guardian Agreement

I give permission for my child to participate in the Big Brothers Big Sisters (BBBS) program.  I understand that BBBS is not obligated to match my child with a volunteer, and as part of the enrollment process I will be asked to provide additional personal information.  I give permission to have a BBBS staff member talk with my child about personal safety.  If my child is matched with a Big Brother or Big Sister I agree to support my child's match and to immediately report any concerns I might have to BBBS staff. 
Publicity and promotional materials for Big Brothers Big Sisters are conducted in a variety of forms. By selecting below, I authorize Big Brothers Big Sisters to identify my child in the media as a program participant using only first name. I also give permission for the use of other forms of media including but not limited to written word, photo, video, social media, and voice recording. 

Authorization For Emergency Medical Treatment

As a parent or legal guardian, I do herewith authorize the treatment by a qualified and licensed medical doctor of my child in the event of a medical emergency which, in the opinion of the attending physician, may endanger the child's life, cause disfigurement, physical impairment, or undue discomfort if delayed.  This authority is granted only after a reasonably effort has been made to reach me. 

Confidentiality Policy

CONFIDENTIALITY POLICY TO BE READ AND SIGNED 

BY BIG BROTHERS BIG SISTERS CLIENTS AND VOLUNTEERS


BBBS 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 organization's professional staff. All records are considered the property of BBBS and not the organization's staff, clients or volunteers themselves.  Records are not available for review by clients or volunteers.


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


  1. Identifying information and/or photos regarding clients and volunteers may be used in organization publications, on the BBBS website or in promotional materials unless the client or volunteer request otherwise.


  1. 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.


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


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


  1. Information shall be provided to the organization's legal counsel in the event of litigation or potential litigation involving the agency.


  1. State law mandates that suspected child abuse be reported to the appropriate authorities of the Department of Social Services.


  1. If a BBBS staff member receives information indicating that a client or volunteer may be dangerous to himself/herself or to others, necessary steps may be taken to protect the appropriate party.  This may include a medical referral or report to local law enforcement authorities.


  1. At the time a child or volunteer is considered as a match candidate, the information shared between the prospective match parties is confidential.  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.



Social Media Consent

Safety of Littles is our number one priority.  

It is very important to keep child safety and confidentiality issues in mind when communicating on social media sites. Bigs will refrain from providing identifying information about their Little online. Also, location of a Little will not be shared on social media channels.  


A parental release form is required for photos. 

In order to release pictures or information about Littles on websites, BBBS needs to obtain a parental consent form. If the parent of the “Little” does not sign this release form, the Big should not divulge any personal information, including first name of the Little and city/state of where they live.


Online privacy does not exist. 

Do not assume that things you publish on a private personal profile cannot be accessed. No matter what settings are applied to your social networking sites, all it takes is for someone to copy and paste that information on to a public site. As a general rule of thumb, do not post content that you would not want to see in the newspaper.


We recommend that your child DOES NOT “friend” their Big through social media channels. 


Youth Safety Guidelines and Grounds Rules for Parents/Guardians

Children’s safety is our #1 priority.  We focus on the child’s safety and well-being throughout the match, not just at the beginning.

We want to work together to keep your child safe.  While our staff carefully screens each volunteer, we need your help to make sure the relationship is healthy and the volunteer is making good judgments about your child’s safety on outings.

  • You should approve all activities; if you are not comfortable with an activity that your child’s Big Brother or Big Sister suggests, you are encouraged not to approve.  Talk to your Match Advocate if you have questions or concerns about match activities.


  • When a Big Brother or Big Sister takes your child out, the Big should always stay with them and not leave them with someone else.


  • Your child’s Big should not use alcohol or other drugs before or during activities with your child.


  • Your child’s Big should not use physical discipline or yell at your child.


  • If an activity involves changing clothes to go swimming, there should be separate changing and showering places.  If they go on an approved overnight (after the 1st year of the match), they need to sleep in separate beds.


  • Volunteers should never ask a child to keep a secret.


  • Volunteers might want to buy an occasional gift for your child.  They will be encouraged to ask your advice about this first.


  • Volunteers should not engage in tickling, wrestling, giving backrubs, or asking a child to sit on their lap.


  • Of course, showing pornography or sexual materials is never acceptable.


We know that you work with your child to teach them skills to help keep them safe from violence whether it’s online, at school, at home, or in your community.  Please feel free to discuss these issues and any other issues related to child safety with your Match Advocate.  We want to work with you to keep your child safe.


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