Youth Application | MAZIE MENTORING 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. 
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Welcome to the Mazie Mentoring Program
Hello and welcome to the "Mazie Mentee" on-line application!

This program is only available to high school students in designated schools.

As a Mazie Mentee child will be matched with a Mentor who has similar interests, is in proximate location, and can compliment the Mentee's areas of improvement. The role of a Mentor is that of a friend, coach, and caring adult.

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

A portion of match meetings will include the opportunity to work towards program goal requirement such as community service.

We provide some structured/sponsored events and encourage free-to-low cost activities. We share ideas through our social media and monthly newsletter, but what the Match does is up to the Big and Little, with prior approval from the Parent/Guardian.

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 Mentee!

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. Thank you for your interest in the Mazie Mentoring Program, managed by Big Brothers Big Sisters of Central Mass/Metrowest (BBBSCM)!

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Youth Information










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This is the year the youth will graduate from high school.




Guardian Information








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












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Family Information









Physical Address




Emergency Contact
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

In this section, we will ask you and your child for permission to use pictures and quotes from them that we may take during BBBSCM meetups (with their mentor or in a group activity). This permission allows us to include your child in content we share with the community (like social media). This permission includes individual content of your child, but also includes content where they might appear in a group photo or activity. By allowing us to share this content, we're better able to share the story of Big Brothers Big Sisters of Central Mass/Metrowest, and encourage others to get involved.

BBBSCM will also never share content that is not positive or celebratory without your approval and your child's approval.

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 COPPA statement is incorporated in the website Privacy Policy here: [AGENCY URL FOR POLICY] 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 admin@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.
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