By checking the box below and providing my signature at the end of this form, I give permission for the following:
1. My child to participate in the Big Brothers Big Sisters Program.
2. The volunteer, screened and approved by Big Brothers Big Sisters, to interact with and transport my child to events and match activities, if allowed by program type.
3. The school to provide social and academic information about my child to Big Brothers Big Sisters, such as report cards and behavior reports.
4. My child to participate in an intake interview and complete questionnaires throughout the program to evaluate and improve services.
5. My child to talk with a Big Brothers Big Sisters staff person about personal safety.
6. 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 I may be asked to provide additional information through an in-person interview, which will be kept confidential unless required by law. I acknowledge that incidents of child abuse or neglect will be reported to the proper authorities. Relevant information about my child will be discussed with the prospective match, including demographic information, preferences, and child safety and well-being.
I certify that all the information on this form is true and correct. I acknowledge that this information may be verified for the receipt of federal funds, and deliberate misrepresentation may result in prosecution under applicable state and federal laws. This information will not affect my qualification for the program.
On behalf of myself and my child, I completely release and forever discharge Big Brothers Big Sisters of Central Mass/Metrowest and its employees, agents, volunteers, and all others involved from any claims, liabilities, obligations, damages, actions, causes of action, suits, demands, costs, losses, debts, penalties, fees, and attorneys' fees arising from participation in the program and activities. This release and discharge are intended to provide the broadest release possible permitted by law and may be shared with the school or partnership agencies when applicable.
If my child is matched with a Big, I agree to support the match by reviewing program and safety information, communicating with Big Brothers Big Sisters staff as outlined in expectations, and promptly reporting any concerns to Big Brothers Big Sisters staff.