BBBS LOGOWPM 18+ Participant Enrollment Form

Mentee Information




Please ensure the YEAR is correct.

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By providing a mobile number, you give Big Brothers Big Sisters permission to contact you using automated text messages for reminders, updates, and events.









Additional Mentee Information
Employment & Education Information




Parent/Guardian Information
The following information is needed to continue processing your application. Your parent/guardian will not be contacted unless noted as your emergency contact in the case of an emergency.


Emergency Contact




Mentee Pre-Enrollment Questionnaire
Prior to your in-person interview, we would like you to answer the questions below. The information you give will also help us make a better match for you and assure we can support you during your involvement with our programs.












Additional Information



Participant Consent
Please initial each item to complete form.
Initials
Initials
Initials
Initials
Initials
Initials



Media Consent and Agreement

Please initial one of the two boxes below and sign and complete all information at bottom of form.

Initials
Initials

Participant Signature
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Communication Consent & Agreement

Please initial one of the two boxes below and complete form with your signature and date.

Initials
Initials

Participant Signature 
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RELEASE AND WAIVER OF LIABILITY

Participant Signature 
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