Youth Application

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Guardian Information





Child Information




In order to enroll a child into our program, you must be a legal guardian of the child.









We collect demographic information for several reasons. The first is to ensure we're giving you and your child the best experience by honoring preferences and making thoughtful matches based on shared life experiences when possible. The second reason is our funders often require us to report this information in aggregate, meaning your child won't be identified individually.

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Address





Medical Information






Emergency Contact




Additional Information

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Pre-Interview Questions













Note: If you chose "Yes" to the above question, after submitting the application you will be automatically directed to another page to complete the "Release of Information" form.

Youth Interest Checklist

Please work through this with your child or allow your child to complete on their own.










Program Policies

Media Release
I hereby authorize Big Brothers Big Sisters of Snohomish County to use my or my child’s image, voice and/or performance to promote the Big Brothers Big Sisters program.  I agree that there will be no compensation whatsoever for this participation or for the use of resulting materials by Big Brothers Big Sisters. I further agree that this participation confers no ownership rights.  Big Brothers Big Sisters of Snohomish County releases me from all liabilities or claims that may result from the existence and use of any such materials. 

Parent & Safety Training

I acknowledge that I am responsible for the information contained in the Parent/Guardian orientation guide and do hereby agree to follow all of the guidelines outlined in the Parent/Guardian contract. (This will be covered in the interview process)

 

I acknowledge that my child and I have participated in the Safety Awareness Training with a member of the Big Brothers Big Sisters of Snohomish County staff.  I further acknowledge my role in protecting my child from abuse as discussed in the training. (This will be covered in the interview process)


Permission to Contact Providers

In some circumstances BBBSSC may use third party community partners to help in serving your child. We may share information you have provided us with these service providers, but remain committed to maintaining the confidentiality and security of your information. Accordingly, we will take reasonable precautions to ensure that there will be no unauthorized release of your confidential information to others.

The Big Brothers Big Sisters’ program model is evidence-based and well-researched. We utilize surveys as a way to determine our program’s success. You and your child will be asked to complete a few surveys while participating in our program. You and your child have the right to decline participation in surveys. From time to time Big Brothers Big Sisters contracts with third party evaluators and in such situations your child’s outcome data will be NOT shared without the use of identifying information such as name and contact information. Confidentiality will be strictly maintained in such situations.

 

Part of BBBSSC’s mission is to help children be successful in school and refrain from activity that would lead to involvement in the juvenile justice system. BBBSSC will rely on information and data from school districts (including grades and attendance records) and other youth-serving organizations to provide the best possible support to your family. My signature below authorizes the school district and any other youth-serving organizations they are involved in to provide information to BBBSSC about my child if such information will be needed to assist the agency in providing the best possible services to my child.  

Release of Liability/Participation

I give permission for my dependents to participate in YMCA/BBBS programs and activities. I understand that accidents can sometimes happen. Therefore, in exchange for the YMCA/BBBS allowing me, and if applicable, my spouse and my dependents to participate in YMCA/BBBS program and activities, I understand and expressly acknowledge that I release the YMCA/BBBS, its employees, its boards, members, volunteers or guests from all liability for any injury, loss or damage connected in any way whatsoever to participation in YMCA/BBBS activities whether on or off the YMCA’s/BBBS’ premises and including transportation. I understand that this release includes any claims based on negligence, action or inaction of the YMCA, its employees, boards, members, volunteers or guests.


Parent/Guardian Program Acceptance & Consent
  1. I understand that BBBSSC is not obligated to match my child in the program and that it may be for any number of reasons that it is not considered a good fit.
  2. I understand that BBBSSC is not liable to give reasons of non-acceptance.
  3. I understand and agree that for the duration of my child’s involvement with Big Brothers Big Sisters of Snohomish County any information that I or my child share with a staff member about personal, health, family or other may be shared at the discretion of the agency staff with potential mentor and with the mentor finally selected for my child, unless I specifically request otherwise. 
  4. I further understand that each staff member and mentor has agreed to abide by the confidentiality practices established by the agency. 
  5. I also understand that BBBSSC is not required to release files on my child to myself or any other party unless required by law but may share content with parties for whom we have a signed release at the agency’s discretion.

Small Group Mentoring Program & Consent

Small Group Mentoring (SGM) is a group mentoring program designed to address the needs of Littles awaiting a one-to-one match and engaging our Bigs. SGM fosters resilience, encourages goal setting, teaches life skills, and provides all wait listed Littles with a caring and supportive environment. The program gives unmatched Littles the chance to meet and work with a role model, while developing relationship with other children and broadening their horizons through interactive activities.


All activities are facilitated by BBBSSC Staff and Bigs. SGM 12 & Under meet one Sunday per month from 11:30 to 1:30 and SGM Teen (12+) meet one Sunday per month from 11:30-1:30 PM at the Everett YMCA or agreed upon location. Activities include (but are not limited to): cooking/baking, arts/crafts, internet technology/safety, discovery science, tutorial sessions, sports, team building games, etc.


All our Community-Based and School-Based 1:1 children are eligible for to join SGM (ages 6-18) upon acceptance until they are matched in one-to-one program.  Littles who are matched in Kids Book Club, MentorU, and/or Beyond School Walls are not eligible. In certain cases, with approval from the Program Director, exceptions to this rule can be made.


Youth placed back on the waiting list after their one-to-one match is closed will be eligible for participation in SGM.


NO contact whatsoever is permitted between a SGM Big and a SGM Little outside a SGM activity or other agency activity. Any break in this agreement will result in immediate removal of the Big from the agency.