Youth "Little" 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, gender, marital status, sexual orientation, gender identity, veteran status, or disability. 
Hidden Fields
To look up the owner's email for notifications
For notifications
Youth Information





Enter a date in the following format: mm/dd/yyyy

Hold CTRL+F to select multiple



This is the year the youth will graduate.
Guardian Information
Type NA if unemployed
Family Information

Physical Address
Emergency Contact
If we are unable to reach you, who is someone we could call who always knows how to reach you?

Additional Questions

Why do we ask questions that often feel so personal? Demographic questions serve two purposes - 1) to help us make the best mentor match as possible for your child, and 2) certain demographic populations are supported by targeted grant funding. All answers provided here are treated confidentially by SLO Bigs team members for enrollment and match support purposes only.

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





Other Siblings and Relatives in the Program
Please choose this child's relationship to the following people:




















Parent/Guardian Agreement

By checking the box below and providing my signature at the end of this form, I give permission:
  1. For my child to participate in the Big Brothers Big Sisters Program;
  2. For the volunteer matched with my child, who has been screened and approved by Big Brothers Big Sisters, to personally interact with and transport my child to events and match activities, if applicable and allowed by program type;
  3. For the school to provide social and academic information about my child to Big Brothers Big Sisters (e.g. report cards, behavior reports);
  4. 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;
  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 for me and my child to the volunteer.
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 San Luis Obispo County (SLO Bigs) 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 SLO Bigs, 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.

Photo Consent and Release Form

I,
,legal parent or guardian of
("Minor Child"), irrevocably consent:
For myself and Minor Child to any and all uses and displays of my or Minor Child’s name, image, likeness, appearance, basic biographical information, audio/video recordings, writings, artwork, and the like, in original form or in modified form, in whole or in part, in, on, or in connection with merchandise, advertising, publicity, marketing, fundraising, and the like, in printed or electronic media, of any type, throughout the world at any time by Big Brothers Big Sisters of America and Big Brothers Big Sisters of San Luis Obispo County (SLO Bigs) in their sole discretion, and by any of their affiliates, successors, partners, sponsors, donors, any entities or persons with whom they conduct any public relations, marketing, or fund raising of any type, and any other authorized third parties, without further consent from me or Minor Child, without any royalty, payment, or other compensation to me or Minor Child, and with the release and waiver of any claims, actions, damages, losses, costs, expenses and liability of any kind arising from any such use (the “Released Material”). In consideration of the mutual promises made herein, and for other good and valuable consideration, the receipt and sufficiency of which I hereby acknowledge, I hereby grant to BBBSA and its affiliates the right to use the Released Material as BBBSA and/or its affiliates may desire, in all media now existing or hereafter created and in all variations and forms including, but not limited to, internal or external publications or productions, informational or recruitment materials, marketing materials, fundraising materials, televised photography and/or recordings, advertisements, Public Service Announcements, and/or online and social media sites. The use of this information shall be at the sole discretion of BBBSA and/or its affiliates. I further grant to BBBSA and its affiliates the absolute right to use the Released Material in whole or in part, alone or in conjunction with any other image, name, writings or reproduction, in color or otherwise, for art, advertising, business, trade, or any other lawful purpose whatsoever, in perpetuity throughout the world. I understand and agree that all materials created by BBBSA and/or its affiliates that use the Released Materials are the property of and are owned by BBBSA, and that I cannot authorize their use by any other party. I further understand that BBBSA may authorize their use by a third party. I hereby irrevocably transfer and assign to BBBSA my entire right, title and interest, if any, in and to the Released Materials and all copyrights in the Released Materials arising in any jurisdiction throughout the world, including the right to register and sue to enforce such copyrights against infringers. I acknowledge and agree that I have no right to review or approve the Released Materials before they are used by BBBSA and/or its affiliates, and that BBBSA has no liability to me or Minor Child for any editing or alteration of the Released Materials or for any distortion or other effects resulting from BBBSA’s and/or its affiliates’ editing, alteration or use of the Released Materials. BBBSA has no obligation to use the Released Materials or to exercise any rights given by this Consent and Release Form. I hereby release BBBSA and its affiliates, employees, and agents, as well as any partner companies, from all claims, demands or liabilities and related financial costs that I or Minor Child may now or hereafter have arising in connection with BBBSA’s exercise of the rights hereby granted, and/or with the appearance or the Released Materials in any publication or production. These include, without limitation, claims for compensation, defamation, or invasion of privacy, or other infringements or violations of personal or property rights of any sort whatsoever.  

COPPA Parental Consent Form

Notice to Parents In compliance with the Children’s Online Privacy Protection Act (COPPA), parents (or legal guardians) of children under 13 years of age must consent to collections, uses and disclosures of the personal information of their children collected by Big Brothers Big Sisters of San Luis Obispo County (SLO Bigs) on SLO Bigs and NATIONAL websites, including slobigs.org, bbbs.org, MatchConnect, bbbsa.force.com, forms.bbbs.org and formstack.io. SLO Bigs COPPA statement is incorporated in the website Privacy Policy. SLO Bigs may have collected your online contact information from your child, as well as the name of the child or the parent, in order to obtain your consent. Your permission is required for the collection, use, or disclosure of your child’s personal information. We will not grant your child access to any BBBS website account unless you provide us with permission. BBBS website accounts provide access to BBBS content, materials, and resources relating to BBBS programs and activities, including information pertaining to matches, activities, agency events, and resources.

You may revoke your consent at any time to refuse further collection and use of your child’s information. If you desire to revoke this consent, please contact our agency at 805.781.3226.

Medical Release







Medical Care Authorization
I authorize Big Brothers Big Sisters of San Luis Obispo County (staff and/or volunteers) to obtain medical and/or surgical treatment for my child in case of illness, accident, or any situation that may arise. These medical services are to be performed by the physician entered below or in his/her absence, any licensed medical doctor. I further state that I will not hold Big Brothers Big Sisters of San Luis Obispo County liable in case of illness, accident, or emergency situation.
Emergency Care Preferences (optional)
Release from Liability

Confidentiality Policy

In order for BIG BROTHERS BIG SISTERS OF SAN LUIS OBISPO COUNTY to provide a responsible and professional service to clients, it is necessary for volunteers, clients, and parents (or guardians) of clients to be asked to divulge extensive personal information about themselves and their families.  This agency 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 agency professional staff.  The right to confidentiality applies to written records, video, film, social media (including, but not limited to the internet, networking sites, blogs and personal websites),  photos, and/or any other depiction of the name, likeness, or other description of a client or volunteer in any publication or promotional material.  

           

All records are considered the property of the agency and not the agency workers, clients, or volunteers themselves.  In order to provide a service which is in the best interest of the children served by the program, information from outside sources, including confidential references, must be assessed along with information gained from the clients or volunteers themselves.  Records are not available for review by the clients or volunteers.  

           

When a Client/Volunteer is considered for a match, information is shared between the prospective parties.  Each party has the right to refuse the proposed match based on the information provided.  Prior to a match being made, information shared may include but is not limited to: first name, age, sex, race, religion, education, interests, hobbies, marriage and family status, sexual orientation, reasons for applying to the program, and a summary of the reasons an individual was chosen for the match.  The individuals to whom the information is provided shall agree not to share the information with any other person.  For the duration of the match and after formal closure, confidentiality is to be maintained by all program participants.

 

Limits of Confidentiality

Information will be released to other individuals or organizations only upon presentation of an authorized "consent to release information" form appropriately signed by the client, client's representative, or volunteer, except in the instance of suspected child abuse.

 

Identifying information regarding clients and volunteers may be used in agency publications or promotional materials only if the client or volunteer has given permission.

 

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.  These outside organizations shall be required to respect the agency policy on confidentiality.  Outside parties shall be required to use information only for the purpose(s) stated in the approval action of the Board of Directors.  Known violations of agency confidentiality policy will be reported to the supervisor of the individual involved, and appropriate disciplinary action shall be requested.

 

Directors of the Board shall be required to comply with the agency policies on confidentiality and may use the information divulged to them only for purposes stated by the approved action of the Board of Directors. 

 

Violations shall be reported to the Board President. A violation of the agency's confidentiality policy by a Director shall constitute adequate cause for removal from office.

 

Any subpoena requesting confidential information received by or served upon the agency shall be immediately delivered to the agency's legal counsel for review and appropriate action.  Only the agency's legal counsel shall have authority to determine whether or not any subpoena served on the agency is valid and/or unenforceable. 

 

Information shall be provided to an agency's legal counsel in the event of litigation or potential litigation involving the agency.  Such information is considered privileged material, and communications between the agency and its counsel are protected by confidentiality law. 

 

State law mandates that suspected child abuse and neglect be reported to the appropriate authorities. All workers are responsible for staying abreast of California reporting requirements and shall always comply with mandated procedures.

 

If an agency worker receives information indicating that a client or volunteer may be dangerous to himself or herself or to others, necessary steps may be taken to protect the appropriate party or parties. This may include a medical referral or a report to the local law enforcement authorities.

 

A known violation of BBBS’s Confidentiality Policy shall result in disciplinary action.  Depending on the seriousness of the violation, the action may be a written warning, suspension or termination of the match and/or employment.

Guidelines and Ground Rules

These rules are based in in-depth studies of mentoring successes and challenges during the last 100+ years since Big Brothers Big Sisters of America began. They are important for ensuring youth safety, adult liability protections, and healthy, happy outcomes for all parties.

GUIDELINES AND GROUND RULES Parent/Guardians and Littes 

As a Parent/Guardian, I will:

1. Understand my actions play a major role in my child’s relationship with their Big.

2. Remember this is a friendship between my child and their Big, and I will not expect 
special favors. The Little is the only person who can go on outings with the Big, unless 
approved through my Match Support Specialist.

3. Decide whether to approve each match activity.

4. Not allow my child to visit their Big’s home within the first 3 months. Thereafter, 
approval must be obtained by our Match Support Specialist. Any visit occurring prior to this approval will result in closure.

5. Have my child appropriately dressed, ready and on time for each outing.

6. Realize that the Big is responsible for the cost of the match outings, which are to be free or low-cost activities. I will help my child not ask for presents or expect expensive outings. 

7. Participate in the match support process and be willing to address challenges as they arise. Initiate and return phone calls, texts, emails, complete surveys/evaluations and attend meetings related to my child’s match. I will respond to contact from my Match Support Specialist at least monthly to report on the progress of the match. I understand that if I do not respond promptly, their match may be closed.

8. Understand that it’s important for my child to consistently meet with their Big, and I 
will not use this time as a reward or a punishment. If I am having difficulties with my 
child, I will communicate them to the Big and my Match Support Specialist, and I will 
work to modify outings or arrange for the Big to meet with my child at our home. 

9. Keep any personal information that I learn about the Big and their family members 
confidential, aside from sharing it with my Match Support Specialist. I will not keep 
secrets from my Match Support Specialist.

10. Agree to follow all guidelines listed in BBBS’s social media policy.

11. I will support BBBS SLO fundraising event so that more children can benefit from having a Big.

12. Communicate my hopes and wishes for my child to their Big.

13. Contact the Big prior to their arrival to pick up my child if they will not be able to go on a planned outing. I will also make arrangements ahead of time with the Big if I cannot be at home when my child is to return. 

14. Give the B i g and Match Support Specialist up-to-date emergency contact phone 
numbers and names, as well as any changes in my phone number, address and place of employment as soon as possible.

15. Encourage my child to communicate with their Big, talking when together and 
returning phone calls. I will help my child by considerate by remembering birthdays, 
making occasional phone calls, keeping appointments, saying “thank you” and being 
polite.

16. Return phone calls, emails, and/or texts from the Big in order to schedule outings with them for my child.

17. Discuss activities with my child after outings and tell my Match Support Specialist if there is anything about the relationship that concerns me. 

18. Monitor communication between my child and their Big (via phone, text, Facebook, 
online video game systems, etc.) 

19. Understand that the Big may not use or be under the influence of alcohol or drugs during a match outing. I will not allow my child to go with them if this ever should occur or if the Big seems unsafe in any way. I will then notify my Match Support Specialist as soon as possible.

20. Not allow any overnights between my child and their Big.Unapproved overnights 
will result in closure.


As a Little, I will:

1. Talk to my Big and tell them how I feel about our activities and outings. 

2. Brainstorm ideas with my Big and help plan fun activities together.

3. Let my Big know that I like to see them and say thank you after our outings. 

4. Talk to my Big and Match Support Specialist on a monthly basis about what I enjoy and if there is anything I do not like about my match.

5. Be willing to try a variety of outings with my Big, unless I feel unsafe.

6. Not ask to bring friends or family members along on activities.

7. Not expect my Big to spend money on me or buy me gifts. 

8. Be respectful and on time

9. Ask my Big and parent before bringing any video games or electronics along on outings. 

10. Understand that when I’m with my Big, my attention should be focused on our
friendship, not on friends, phones or electronic devices. 

11. Understand that if I feel uncomfortable, I can say “no” to an outing or activity and/or ask to be taken home. 

12. Follow safety rules when on activities with my Big, including wearing my seatbelt. I will also sit in the backseat if I am younger than 13.

13. Agree to follow all guidelines listed in BBBS’s social media policy. I will let my 
parent/guardian know if I am communicating with my Big through phone or social media (calls, texting, Xbox Live, PlayStation Live, email, Facebook, and other social media outlets), and I will ask permission before using a new type of social media to communicate with my Big.

14. Tell my parent/guardian and Match Support Specialist if I am uncomfortable about 
anything that happens with my Big. I will not keep secrets from my Match Support 
Specialist about my Big or my match.

15. Strive to do well at home, in school and in the community.

It is essential that all participants understand these Guidelines and Ground Rules, so please reach out to your Enrollment or Match Support Specialists at any time if you have any questions.
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