consent to the disclosure of the following information to a potential match
for me or for my child.
sex, race, religion, gender identity, interests, hobbies, martial and family
status and background, history of abuse, sexual preference and views, living
situation, education and employment, criminal and driving record check, reasons
for applying for the program, and a summary of why individual was chosen.
Child: Age, sex, race, religion, gender identity, interests, hobbies, family
history, status and living situation, history of abuse, school and other agency
involvement, a summary of clients needs assessment and expectations for match
I understand that I or my child will not be identified by full name until after a
match has been agreed upon by both parties. I also understand that I have the right to
refuse to enter a match based on anonymous information shared.
I I agree to keep information discussed
with me regarding a potential (Big Brother/Big
Sister or Little Brother/Little
Sister) match confidential. I will not
information with any person other than the assigned professional
staff of the Big
Brothers Big Sisters agency.