High-Risk Activity Permission Form

What is the activity?

Dates of Activity:

[Leave blank if no end date]

I realize that Big Brothers Big Sisters of the Midlands (BBBSM) views this as a high-risk activity and that BBBSM is not liable for anything that occurs during this activity. I also understand that this activity is out of the scope of BBBSM’s program. I assume all responsibility through giving my permission for my child and their Big(s) to participate in the activity. It is also understood that BBBSM is not financially liable, under any circumstances, should an accident occur.

Your First Name

Your Last Name

Your Primary Email Address

Mentee's/Child's First Name

Mentee's/Child's Last Name

By clicking submit, you acknowledge and will adhere to the information that BBBSM has presented above.

After submitting this document, you will be redirected to another page where you will complete an e-signature. To verify this signature, an email will be sent to your primary email address with a link to do so.

Match ID

Match Owner Email

Contact Information