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High School Bigs Youth Application

High School Bigs Mentoring Program Overview 

Dear Parent/Guardian:

 

Your child has the opportunity to participate in the Big Brothers Big Sisters of Metropolitan Chicago (BBBSChi) Site Based Mentoring Program. In this free program, your child is matched 1:1 with a high school aged Volunteer Mentor.  They will meet with other matches, and there will be BBBSChi Staff to supervise and facilitate all of the program sessions. 


Thank you.


--BBBSChi Staff

Program Site Location


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Hidden Fields

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Referral Detail

Type 'BBBS Board/Staff'...then select the staff name who referred you.

Youth Information
Please note that all information requested in this application will be kept confidential and will not be released without your permission. 






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This is the year the youth will graduate.







Youth Health Information





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Enter N/A if none
System Involvement
The questions below help us to inform programming, partnerships, and how we individually serve each youth. We do not pre-judge youth or families due to their answers; responses provide us with the clearest picture on how to meet the individual child’s needs.



Guardian Information











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Type N/A if unemployed


Family Information















Residential Address







Existing Household Members
Please choose this child's relationship to the following people:



Emergency Contact




Youth Needs & Match Preferences





Media Consent

I, as the legal parent or guardian of my child for whom I have completed this application, 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, [BBBSA affiliate], 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.


My child’s assigned Big Brother/Big Sister may post photographs and share information about the match on social networking websites.  I understand Bigs may be allowed to post my child’s first name but no other identifying information (i.e. last name, home address, school the child attends, etc.)  

Expectations & Guidelines for Parents/Guardians

I understand that: 

  • BBBSChi is not obligated to accept my child for the Big Brothers Big Sisters program. Furthermore, BBBSChi reserves the right to withhold the reasons for non-acceptance.  

  • All information obtained regarding my child will be held in confidence by BBBSChi. I will only have access to my application. All other information concerning my child, including but not limited to information derived from the enrollment process, interviews or otherwise, will be the sole property of BBBSChi. Information about my child, as it pertains to the matching process, may be shared with teachers, counselors, youth partner staff, BBBSChi staff, and volunteer mentors. BBBSChi will not release to outside sources, unless required by law, information from my child’s enrollment file, without my prior written consent. 

  • My child is expected to attend, at minimum, at least 80% of all scheduled program sessions. If my child is unable to attend a program session, either I or my child must inform BBBS Staff. Failure to comply with these attendance requirements may result in the closure of my child's match and my child not being able to participate in the program. 

  • My child is not allowed to meet 1:1 in-person with their mentor, outside of the supervised program sessions/BBBSChi supervised field trips/events.   

  • My child is allowed to game on all video game platforms with their mentor. The timing of gaming between Big and Little should be coordinated with the parent/guardian and BBBS Staff. Ensure video game content is age appropriate. Social networking between mentors and my child is strictly prohibited.

  • BBBSChi and my child's mentor may communicate with my child via phone, email, text, BBBS' TheApp and other video platforms.  Video chatting should only occur in common areas of the home and when parents/guardians are present. 

  • On-going match support will occur with my child in order to monitor the match, provide support and resources. 

  • Communication is vital to the success of the mentoring relationship. My child or I may be contacted by BBBS Staff to have a conversation about my child's match relationship and experience in the program. Phone calls and emails received from BBBSChi staff must be returned/replied to within 48 hours. 

  • My child’s mentor can attend up to 3 of my child’s out of program, public events per year if I give written/verbal permission to the Coordinator for each event. My child’s mentor may never transport my child at any time. 

  • My child will complete program questionnaires as well as talk to BBBSChi staff and BBBSChi volunteer mentors about topics including, but not limited to, school, home life, personal interests, and personal safety. 

  • My child will participate in assessments and evaluations in regards to the BBBSChi program.  

  • I may be invited to attend program session or Parent/Guardian meetings throughout the year, which I will make every effort to attend. 

  • My child may ride a school bus for in-person program sessions and/or to participate in BBBSChi group field trips. 

  • The School District, School, Institution or Youth Serving Organization my child attends can release the following information to BBBSChi quarterly or as requested, including such information as grade point average, photocopies of report cards, school attendance, grade advancement, student ID#, graduation information and noted social and academic information (i.e. relevant behavior reports and/or counselor/social worker feedback).   

  • BBBSChi staff will hold my child’s disclosures related to the child’s gender identity and/or sexual orientation confidential if my child does not want that information shared with me. Agency staff will encourage my child to find a safe and supported way to share this information with me when the child is ready to do so.  

  • Keeping my child safe is a priority for BBBSChi and I understand that I play a role in this, including: asking my child about their mentor and the activities they participate in, informing the staff if I have any concerns regarding my child’s relationship with their mentor, and monitoring that all rules are being followed.

  • BBBSChi staff are mandated by the Illinois Abused and Neglected Child Reporting Act to report any concerns or suspicions and/or incidents of abuse or neglect.  

Parent/Guardian Agreement & Permission Form

I agree to let my child participate in the BBBSChi Program. I understand that certain risks and dangers may exist in my child’s/ward’s attendance and participation in this Program is conditioned upon my agreement to release any claims of liability, including, but not limited to, any claims for property loss or personal injury to my child/ward.  Therefore, in exchange for my child/ward attending and participating in the Program, I hereby voluntarily release BBBSChi , its board, officers, staff, employees and volunteers from all claims which I or my child/ward may have for liability or legal responsibility for any damage or loss of any kind, including, without limitation, claims for personal injury, property damage or loss, and economic loss occurring during or resulting from my child’s attendance and/or participation and/or travel to or from their school/site or field trip/program destinations which is caused by negligence, breach of contract, strict liability, or otherwise. 

  

I give permission for (1) my child to participate in the Big Brothers Big Sisters Program; (2) the school my child attends, or any other entity holding academic or other information about my child, to provide social, academic, and other information/ records about my child to BBBSChi that are useful or necessary in assessing, planning or implementing educational interventions by BBBS staff (e.g. report cards, phone numbers, STAAR/ EOC exams/ standardized test scores, attendance records, behavior reports/ referrals, counselor and teacher reports, special education referrals and tests, free/reduced lunch status, etc.); (3) BBBSChi to disclose information to school representatives for the purpose of assessing, planning or implementing educational interventions (e.g. identifying information such as name, school ID, and social security number); (4) my child to complete a questionnaire containing questions about school, home life, and personal interests; (5) my child to speak with a BBBSChi staff person about personal safety; (6) my child to communicate with their volunteer and BBBS in person, over the phone, by text, email, mail, BBBS’ TheApp or using other virtual technology/platforms; (7) my child to be transported by bus for any in-person program sessions or field trips.

 

Click 'SUBMIT' below to submit your application. 

NOTE: A Parent or Guardian must digitally sign this application!

After you have clicked 'SUBMIT,' you will be prompted to enter your name, email and digitally sign this application. An automated email will be sent to you, confirming your application has been submitted and will also include a link for you to confirm your digital signature. 

You MUST click the link in your email in order to complete the application process. After confirming your signature, a BBBSChi staff member will be in contact with you to discuss next steps in your child's enrollment process.

Thank you!

Contact Information