STATEMENT OF RESPONSIBILITY AND PERMISSION

I understand the expectations of the Sports Buddies Program. I agree to allow my child to attend Sports Buddies events set up by Big Brothers Big Sisters of Middle Tennessee. I understand that Big Brothers Big Sisters of Middle Tennessee and their staff/volunteers shall not be liable or held responsible for injuries, death, loss or other damages.

Our agency offers child safety training for parents and guardians entitled “Your Child’s Personal Safety.” This Training is not required for your child to be matched with a mentor but is highly recommended. Please include your email address on this application and you will receive an email from training@bbbsa.org, our training website called The Learning Exchange (TLE), which will prompt you to log in. If you do not have an email address or did not receive the email and would like to take the training, please contact us and we will provide you with assistance.

I have read the above statement and being the Parent/Legal Guardian, hereby give permission for my child (listed below) to participate in the Sports Buddies Program and all its activities. I authorize medical treatment for my child in the event of an emergency when I cannot be reached.

Youth's First Name

Youth's Last Name

Parent/Guardian Contact Information

Parent/Legal Guardian First Name

Parent/Legal Guardian Last Name

Street Address

City

State

Zip Code

Home Phone

Work Phone

Cell Phone

Email Address

In Case of Emergency Contact

Emergency Contact First Name

Emergency Contact Last Name

Phone

Emergency Contact Relationship to Youth

Please list any medical problems or allergies:

Contact Information