Parent Reference and Consent

Parent Reference and Consent - High School Big

Save my progress and resume later | Resume a previously saved form

Resume Later

In order to be able to resume this form later, please enter your email and choose a password.

Your Email:

A Password:

Confirm Password:

Password must contain the following:

12 Characters
1 Uppercase letter
1 Lowercase letter
1 Number
1 Special character

Hidden Fields

Contact ID 18 Character

Enrollment ID 18 Character

Contact Owner ID

Contact Owner Email

Basic Information

Your Child's First Name

Your Child's Last Name

Your Child's School Email:

Your Child's Birthdate:

Your Name:

Your email:

Your phone number:

Parent Reference

In serving as a reference for your child's application as a High School Big, please answer the following questions:

Do you believe your son/daughter will be a good mentor and a positive role model for a younger student? Why or why not?

Describe your son/daughter's personality and interests (e.g., shy or outgoing, prefer indoor or outdoor activities, trustworthy, reliable, consistent)?

Do you believe your son/daughter can fulfill a commitment to the Big Brothers Big Sisters program for a minimum of one year? If no, please explain any concerns you have.

Have you observed your son/daughter interacting with younger children? If so, can you describe how your son/daughter interacts with younger children?

What reservations or concerns do you have about your son/daughter's participation in the Big Brothers Big Sisters program?

Volunteer Agreement

In order to participate in the Big Brothers Big Sister program, your son/daughter must abide by the following:

I understand that seeing my Little Brother/ Little Sister consistently is one of the most important things I can do as a Mentor; therefore, I will commit to seeing my Little one-hour per week.
I understand that all contact with my Little is restricted to school grounds.
I understand that the relationship between my Little and me is a one-to-one relationship.
I understand that I might be privy to personal information about my Little and family members which I will keep confidential.
I will maintain regular contact with the Big Brothers Big Sisters Program Coordinator by responding to calls and letters/emails.
If a problem arises in my match relationship, or my contact information changes, I will notify the Program Coordinator immediately.
I understand that I will be asked to participate in a program evaluation which includes completing a 3 month and an annual survey.
I will adhere to school procedures and guidelines for match visits, and will contact the Program Coordinator if I am unable to meet with my Little.

Although our focus is on the Little, please, remember that the staff at Big Brothers Big Sisters is here for you also. Please, do not hesitate to call us if you have any questions or concerns, no matter how small they may seem to you.

Publicity Consent

I, as the legal parent or guardian of the child named below (“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, and basic biographical information in, on, or in connection with any advertising, publicity, marketing, or printed or electronic media, of any type, throughout the world at any time by Big Brothers Big Sisters of America, Big Brothers Big Sisters of Central Carolinas, and any of their affiliates, successors, partners, sponsors, donors, and any entities or persons with whom they conduct any public relations, marketing, or fund raising of any type 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.

Opt InOpt Out

Minor Child:

Participation Consent

I give permission for my daughter/son to volunteer as a High School Big Brother or Big Sister. I have read and co-signed, with my child, the Big Brothers Big Sisters Volunteer Application and understand that she/he is committing to be a volunteer mentor for at least one school year and that she/he will spend about an hour each week mentoring a younger child (except during school breaks). I understand that his/her involvement in the Big Brothers Big Sisters program will be under the guidance of Big Brothers Big Sisters Staff and that she/he is required to abide by all program rules and expectations.

I also understand that transportation to/from the program site is the responsibility of the High School volunteer.

I feel this is a good opportunity for my son/daughter and fully support and recommend his/her involvement as a mentor in the Big Brothers Big Sisters program.

I accept the terms and conditions.

YesNo

Signature Block

I have read the above statements and accept them as conditions for participating in the Big Brothers Big Sisters of Central Carolinas program. All parties agree that electronic/digital signatures are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility.

I agree

By selecting the "I accept" button, you are signing this agreement electronically. You agree that your electronic signature is the legal equivalent of your manual signature.

I accept

Printed Signature:

Save my progress and resume later | Resume a previously saved form

Contact Information