and agree that: 1) I am not obligated, if called upon, to perform the volunteer
services herein applied for and the agency is not obligated to assign me a Little; and 2) as a part of the agency's selection process, police
records, employment history and automobile insurance will be checked by professional
agency personnel. I certify that all of the information
given in this application is true and accurate to the best of my knowledge and
further authorize Mid Michigan Big Brothers Big Sisters and its satellite programs to use
proper channels to verify the same.
I authorize Mid Michigan Big Brothers Big Sisters to submit information from this application to Datasource, DHHS, Michigan State Police and County Police, and online and national background check services for a full criminal background check. I agree that if I become a volunteer that periodic background checks can be conducted during the term of my volunteerism
that all of the information I have provided to Mid Michigan Big Brothers Big
Sisters and all programs may be substantiated by my employment, character
references, records of law enforcement agencies, or courts of law and
give my permission to do so.
I understand Big Brothers Big Sisters requires all adult members of the household in which I reside to complete a criminal background check. I further understand that any member of my household may refuse to have a criminal background check done. The refusal will be noted in the case notes, brought to the attention of the parent at the time of the match and possible could result in my being declined as a Big. I understand the responsibility for the child I am matched with is ultimately mine. Big Brothers Big Sisters discourages anyone other than the volunteer from transporting the child.
I irrevocably consent to any and all uses and displays of my 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 American and Mid Michigan Big Brothers Big Sisters 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, without any royalty, payment, or compensation to me, 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
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 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 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.
“Social Media” is also called “social networking,” but this policy is to provide guidance on Mid Michigan Big Brothers Big Sisters expectations regarding the use of social media by its participants in an appropriate manner.
While Mid Michigan Big Brothers Big Sisters respects your privacy and your right to free speech, you also have responsibilities when you voluntarily put information into the public domain. If you engage in conduct while using social media, as defined below, that is false, violates MMBBBS policies, is inflammatory, or constitutes violations of the privacy of others, you could be subject to immediate removal from the program and also personal liability.
Social Media refers to activities that integrate technology, social interaction and the sharing of words, pictures, videos and audio, such as”:
As a participant of Mid Michigan Big Brothers Big Sisters, your actions, speech, and statements whether in person, on the phone, in print, or online are reflective of our organization as a whole. Before you post information online that relates in any way to MMBBBS or your “Match” please review and become familiar with the following guidelines.
I UNDERSTAND THE FOCUS OF THE
PROGRAM IS TO BUILD A POSITIVE RELATIONSHIP, AND BY AGREEING TO ACT AS A ROLE
MODEL FOR THIS CHILD, THEREFORE I
1. This is a one-to-one match relationship. I will avoid the inclusion of others during
our match activities.
2. Keep information that I may
learn about my Little and his or her family confidential. I will show respect
for the privacy of my Little and their family.
3. Maintain regular contact
with Big Brothers Big Sisters staff by responding to calls, letters, emails
& text and by returning needed paperwork.
4. Respect the personal space
of my Little and avoid inappropriate physical contact.
5. Wait three months to bring
my Little to my home. After three
months, matches are encouraged to participate in MMBBBS group activities and
activities in the community, but may visit the volunteer’s home with parental
6. Never leave my Little
unattended or alone with any other person during match activities unless they
are a fully screened volunteer or Big Brothers Big Sisters staff.
7. Limit gift giving to special
occasions, and will receive prior approval from the parent or guardian or
8. Maintain open communication
with my Little and their parent or guardian, always notifying parent/guardian
about match activities and never asking my Little to keep a secret.
9. Not arrange overnight
activities with my Little. Requests for
exceptional circumstances may be submitted to the caseworker prior to activity
for Executive Director consideration and approval.
10. Not contact my Little via
the internet for the first six months of the match.
11. Avoid disciplining my Little
when we are together, leaving that responsibility to his or her parent.
12. Not approach school
employees, counselors, doctors or others in concern of Little or their family
without prior permission from their parent or guardian or agency staff.
13. Disclose ownership of any
weapons at enrollment and throughout the life of the match. I also agree to
keep all weapons and ammunition safely stored while my Little is in my care.
14. Agree to volunteer a min. 4
hours per month for a min. of 1 year.
This is done with regular contact weekly/bi-weekly arranged with parent
15. Notify Big Brothers Big
Sisters staff immediately:
A) Should MY contact information change or if a situation arises that may
affect my match, including but not limited to serious illness, change in
marital status, contact with law enforcement, etc.
B) A problem or concern about
the match or child arises.
C) Should you suspect child
abuse or neglect.
16. As a role model I will :
A) Abstain from any use of alcohol, drugs, tobacco in the presence of my Little, or immediately prior to visit and I agree to avoid situations in which others are engaging in this type of activity.
B) Not engage in activities activities that pose a risk of injury to my Little during match activities, such as speeding, not using seat belts, consuming alcohol or drugs, etc.
C) Keep my internet presence role model appropriate, including any information posted on social networking sites.
1. Recognize that my match is one-to-one relationship and
therefore, I will avoid the inclusion of
others during our match activities.
2. Keep information that I may learn about my Little and
his or her family confidential. I will show respect for the privacy of my
Little and their family.
3. Maintain regular contact with Big Brothers Big Sisters
staff by responding to calls, letters and e-mails. I will also complete evaluations as requested
by Big Brothers Big Sisters staff.
4. Contact Big Brothers Big Sisters staff immediately if a
problem arises in my match relationship.
5. Notify Big Brothers Big Sisters staff should my contact
information change or if a situation arises that may affect my match, including
but not limited to serious illness, change in marital status, contact with law
6. Actively participate in the closure procedure as
requested by the Big Brothers Big Sisters staff when my match relationship
comes to an end.
7. Respect the personal space of my Little and avoid
inappropriate physical contact.
8. Limit gift giving to special occasions, and will
receive prior approval from the parent or guardian or agency staff.
9. Keep my internet presence role model appropriate,
including any information posted on social networking sites.
disciplining my Little when we are together, leaving that responsibility to
11. Agree to volunteer a minimum of weekly for a minimum
of one school year.
my Little or the Big Brothers Big Sisters office prior to a scheduled meeting
if unable to keep the appointment.
from the use of electronics during my time with my Little.
match contact only at the mentoring site and/or designated meeting areas.