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.