Youth Application | COMMUNITY PROGRAM

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: Community Program

Welcome to the "Little" online application!

Your child, as a Little, will be matched with a Big who shares similar interests and is nearby.

The role of a Big is to be a friend, coach, and caring adult. We recommend that your child meets with their Big 1-4 times a month for a total of at least 4 hours.

We encourage Bigs and Littles to commit to a year-long relationship, but many matches decide to continue for several years with our support.

We offer structured/sponsored events and encourage free-to-low cost activities. While we share ideas through our social media and monthly newsletter, the activities done with the Big require prior approval from the Parent/Guardian.

All Matches and Parent/Guardians are supported by a team of BBBS Staff, providing a specialist to answer questions, assist with goal setting, offer advice, and suggest meaningful activities for the mentoring relationship.

As a caring and careful organization, we have administrative requirements for our Bigs, including background checks, motor vehicle records, and proof of auto insurance.

The application process takes around 20 minutes and is the first step to enrolling your child as a Little!

www.BigsCM.org

Serving Massachusetts Communities In Central Mass & Metrowest Areas

Hidden Fields

Youth Contact Owner ID

To look up the owner's email for notifications

Youth Contact Owner Email

For notifications

Youth Contact ID

Youth Enrollment ID

Additional Youth Found

YesNo

Guardian Information

Guardian Contact ID

First Name

Last Name

Preferred Name/Nickname

Gender/Gender Identity

How do you identify?

Personal Pronouns

What pronouns do you use?

Preferred Language

In addition to contacting you regarding the enrollment process, our program requires that parents/guardians are available to communicate with a staff member once a month to provide match support.
Please provide reliable forms of communication.

Mobile Phone

Home Phone

Work Phone

Work Phone Ext

Preferred Phone

Best Time to Call

Personal Email

Work Email

Alternate Email

Preferred Email

Contact Preference

I understand that failure to respond to agency outreach will result in my child being ineligible to participate in the program.

Employer

Type NA if unemployed

Do you have legal custody of this youth?

YesNo

Guardian's Relationship to Youth

Is there a person who shares custody of this youth?

YesNo

Name

Phone

Are they aware and supportive of the youth's enrollment in the BBBS program?

YesNo

Emergency Contact

If we can't reach you, who is someone we could call who always knows how to reach you?

This person should not be the same as the listed Parent/Guardian.

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone

Emergency Contact Relationship to Youth

By checking the box below and providing my signature at the end of this form, I permit the following:

1. My child is 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 is 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 is 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.

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.

If not prepared by parent or guardian, please sign your full name below and indicate your relationship here

Please enter your full name as signature

Date

American Indian or Alaska Native	Asian - Chinese
Asian - Filipino	Asian - Indian
Asian - Japanese	Asian - Korean
Asian - Other	Asian - Vietnamese
Black or African American	Hispanic - Cuban
Hispanic - Mexican,Mexican American,Chicano	Hispanic - Other Latinx or Spanish origin
Hispanic - Puerto Rican	Middle Eastern or North African
Pacific Islander - Chamorro	Pacific Islander - Native Hawaiian
Pacific Islander - Other	Pacific Islander - Samoan
White or Caucasian	Other
Prefer not to say

English	Spanish
African Languages (Swahili, Bantu)	American Sign Language
Arabic	Asian: Other
Chinese	Creole
Dutch	Eastern European (Czech, Slovak)
French	German
Greek	Hebrew
Hmong	Indian (Hindi, Punjabi)
Italian	Japanese
Keres (West)	Korean
Nordic	Persian
Portuguese	Russian
Turkish	Lao

Name:	Relationship:
Application/Enrollment ID	Contact ID

Poor grades	Skipping school/classes
Behavior problems	Has been suspended
Has been expelled	Sent to an alternative school
None

Special education	Speech therapy
Tutoring	In-school counseling
Other counseling	None