Youth Application | SITE BASED PROGRAM

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Non-Discrimination Policy
Our participants come to us with a wide range of personal characteristics. We believe that participant eligibility shall be determined without regard to race, color, religion, national origin, immigration status, gender, marital status, sexual orientation, gender identity, veteran status, or disability. 
Welcome to the Site Based Program
Hello and welcome to the "Little" on-line application!

This program is only available to participants in designated locations.

As a Little in a Site Based Program your child will be matched with a Big who has similar interests and is in proximate location.

The role of a Big is that of a friend, coach, and caring adult.

We request that Bigs and Littles commit to a year-long, consistent relationship, but often matches decide together to continue in these special, supported friendships for several years.

All Matches and Parent/Guardians are supported by a team of BBBS Staff, which means they will have a specialist who can: answer questions, provide tools to help the match navigate goal setting, offer advice, and inspire activities to make the mentoring relationship meaningful and rewarding.

This application process should take no longer than 20 minutes to complete and it is the first step to enrolling your child as a Little!

As a caring and careful organization, we do have several pages of administrative requests, including: background checks, motor vehicle records, and proof of auto insurance. 
Hidden Fields

To look up the owner's email for notifications

For notifications









MM/DD/YYYY





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Can't find your child's school? Choose: "School Not Listed"

ATTENTION: This is the year your child is expected to graduate from high school













Please provide reliable forms of communication so that we may contact you and your child in regards to enrollment and program requirements












Type NA if unemployed






















If we are unable to reach you, who is someone we could call who always knows how to reach you?




Additional Questions






Other Siblings and Relatives in the Program
Please choose this child's relationship to the following people:































We will make every effort to honor your preferences for your child's mentor. BBBS does not discriminate on the basis of race, ethnicity, gender, gender presentation, marital status, sexual orientation, or religion.

Parent/Guardian Agreement

By checking the box below and providing my signature at the end of this form, I give permission:
  1. For my child to participate in the Big Brothers Big Sisters Program;
  2. For the volunteer matched with my child, who has been screened and approved by Big Brothers Big Sisters, to personally interact with and transport my child to events and match activities, if applicable and allowed by program type;
  3. For the school to provide social and academic information about my child to Big Brothers Big Sisters (e.g. report cards, behavior reports);
  4. To have my child participate in an intake interview conducted by Big Brothers Big Sisters staff and complete questionnaires throughout their time in the program containing questions about school, home life, the match, and personal interests to evaluate and improve program services;
  5. To have my child talk with a Big Brothers Big Sisters staff person about personal safety;
  6. For BBBS staff to provide contact information for me and my child to the volunteer.
I understand that the program is not obligated to match my child with a volunteer and that as part of the enrollment process, I will be asked to provide additional information through an in-person interview. I understand that the information I provide in the enrollment process will be kept confidential, unless disclosure is required by law. I understand that incidents of child abuse or neglect, past or present, will be reported to proper authorities. I understand that certain relevant information about my child will be discussed with the volunteer who is a prospective match (i.e. demographic information, information relevant to volunteer preferences, and information relevant to child-safety and well-being). I certify that all of the information on this form is true and correct and that all income is reported. I understand this information is being given for the receipt of federal funds, that the information on this application may be verified, and that deliberate misrepresentation of the information may subject me to prosecution under applicable state and federal laws. I understand this information will not affect my qualification for the program. I, on behalf of myself and my child, completely release and forever discharge Big Brothers Big Sisters of Central Mass/Metrowest and its employees, agents, members, volunteers and all other persons on its behalf, together with any successors in interest, heirs, attorneys, agents, representatives, and all persons acting by, through, under, or in concert with them from all known and unknown charges, complaints, claims, grievances, liabilities, obligations, promises, controversies, damages, actions, causes of action, suits, rights, demands, costs, losses, debts, penalties, fees, wages, attorneys’ fees and costs, and punitive damages of any kind or nature whatsoever, whether known or unknown, which I may have, or may have had, against Big Brothers Big Sisters of Central Mass/Metrowest, arising from any participation in said program and activities, including but not limited to any liability to any right of action that may occur to such child directly, or to me as their guardian. I intend and understand that this release and discharge is to be interpreted and enforced so as to provide the broadest release and discharge possible as may be permitted by law. I understand that this information may be shared with the school or with partnership agencies when applicable. If my child is matched with a Big Brother or Big Sister I agree to support my child’s match by reviewing the program and safety information given to me by Big Brothers Big Sisters, communicating with Big Brothers Big Sisters staff as outlined in expectations (which includes communication at least once a month in the first year of the match), and immediately reporting any concerns I might have to Big Brothers Big Sisters staff.

Photo Consent and Release Form

I,
,legal parent or guardian of
("Minor Child"), irrevocably consent:
For myself and Minor Child to any and all uses and displays of my or Minor Child’s 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 America and [BBBSA affiliate] 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 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 (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 affiliates. 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 or Minor Child 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 or Minor Child 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. 

 

COPPA Parental Consent Form

Notice to Parents In compliance with the Children’s Online Privacy Protection Act (COPPA), parents (or legal guardians) of children under 13 years of age must consent to collections, uses and disclosures of the personal information of their children collected by Big Brothers Big Sisters of Central Mass & Metrowest on Big Brothers Big Sisters of Central Mass & Metrowest and NATIONAL websites, including bbbscm.org, bbbs.org, MatchConnect, bbbsa.force.com, forms.bbbs.org and formstack.io. Big Brothers Big Sisters of Central Mass/Metrowest may have collected your online contact information from your child, as well as the name of the child or the parent, in order to obtain your consent. Your permission is required for the collection, use, or disclosure of your child’s personal information. We will not grant your child access to any BBBS website account unless you provide us with permission. BBBS website accounts provide access to BBBS content, materials, and resources relating to BBBS programs and activities, including information pertaining to [MATCHES ETC.] 

You may revoke your consent at any time to refuse further collection and use of your child’s information. If you desire to revoke this consent, please contact our agency at programs@bbbscm.org

Youth Safety Guidelines and Grounds Rules for Parents/Guardians

I understand that the program is not obligated to match my child with a volunteer and that as part of the enrollment process I will be asked to provide information through an in-person interview. I understand that the information I provide during the enrollment process will be kept confidential, unless disclosure is required by law and with exceptions noted. I understand that incidents of child abuse or neglect, past or present, must be reported to proper authorities. I understand that certain relevant information about my child will be discussed with the volunteer who is a prospective match (for example, demographic information, information relevant to volunteer preferences and information relevant to child-safety and well-being).

I certify that all of the information on this form is true and correct to the best of my knowledge and that all income is reported. I understand this information is being given for the receipt of federal funds, that the information on this application may be verified and that deliberate misrepresentation of the information may subject me to prosecution under applicable state and federal laws. I understand this information will not affect my child’s qualification for this program. 


I do hereby release the organization and its employees, agents, members, volunteers and all other persons on its behalf from any and all liability for any damage or injury which such child might sustain while participating in said program and activities, including but not limited to any liability to any right of action that may occur to such child directly or to me as his/her parent/guardian. I understand that this information may be shared with my child’s school or with partnership agencies when applicable. 


If my child is matched with a Big Brother, Big Sister or Big Couple, I agree to support my child’s match by reviewing the program and safety information given to me by Big Brothers Big Sisters of Central Mass/Metrowest, communicating with Big Brothers Big Sisters staff as outlined in expectations (which includes communication at least once a month during the first year of the match) and immediately reporting any concerns I might have to Big Brothers Big Sisters staff. 


By signing below, I give permission:


1. For my child to participate in Big Brothers Big Sisters of Central Mass/Metrowest community or site mentoring program

2. For the volunteer matched with my child, who has been screened and approved by Big Brothers Big Sisters, to transport my child to events and match activities

3. For the school to provide social and academic information about my child to Big Brothers Big Sisters (report cards, behavior reports, etc.)

4. To have my child participate in an in-take interview conducted by Big Brothers Big Sisters staff and complete questionnaires throughout his/her time in the program pertaining to topics such as school, home life and personal interest

5. To have my child talk with a Big Brothers Big Sisters staff person about personal safety; and 

6. For Big Brothers Big Sisters staff to provide contact information for me and my child to the volunteer. 

Disclosure of Non-Discriminatory Policy

I understand that Big Brothers Big Sisters of Central Mass and Metrowest is committed to the inclusion of all people and seek to support all identities.
I understand that Big and Littles will not be excluded from the program based on race, ethnicity, gender identity, sexual orientation, ability, or religious preference.
I understand that Match support specialists may be able to accommodate matches based on similar affinities. However, with the exception of matching like gender identities, which is currently a requirement, all Bigs and Littles may be matched with a person who identifies as a member of any race, ethnicity, sexual orientation, ability or religious preference.
I understand that Big Brothers Big Sisters of Central Mass and Metrowest stands on the inclusion of others as a core value.