BBBSI Community-Based Youth Application

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A Note About this Application
Thank you for your interest in Big Brothers Big Sisters Independence Region! BBBS is a donor-supported, nonprofit organization that strives to create and support successful, one-to-one mentoring relationships for the youth in our community.

We serve children ages 7-13 who reside in Philadelphia, Chester, Montgomery, Delaware, Camden, Gloucester and Burlington Counties.
 Applications must be completed by the parent or legal guardian.  If you are not the child’s parent or legal guardian, please share our information with the appropriate guardian who has legal custody of the child. 
 Please include a valid email address to fill out this application. If you do not use email or have trouble completing this form, please call us at (215) 790-9200 to open your child's application. After you complete the application, a team member from BBBSI will contact you once we have identified a mentor in your area. Please note that this process may take a few weeks or months, all dependent on the volunteers we have available in your area.
By providing your mobile number, you consent to receive text messages from Big Brothers Big Sisters regarding your application. Standard message and data rates may apply. You may opt out at any time by replying STOP. https://www.independencebigs.org/privacy-policy/ 
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, gender, marital status, sexual orientation, gender identity, veteran status, or disability.  Due to the complexities of matching, BBBSI does not guarantee a match.
Hidden Fields
To look up the owner's email for notifications
For notifications
Youth Information
Enter a date in the following format: mm/dd/yyyy
At this time we are only accepting applications for youth ages 7-13. 

Hold CTRL+F to select multiple

This is the year the youth will graduate.
Guardian Information
Please enter a date in the following format: MM/DD/YYYY
Please type NA if unemployed
Family Information

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

Matching Questions and Additional Information






** Press CTRL or Shift and click to select multiple preferences.                                                                            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. Please be aware that strict preferences regarding a Big will likely increase the time a Little spends waiting to be matched.   
The confidential information asked for in this section is used only for reporting and funding purposes. 








Please begin typing your answer (e.g. Friend, Work, etc.) and a list of related referral sources will appear. Please pick the most similar referral source from the list.
Other Siblings and Relatives in the Program
Please choose this child's relationship to the following people:


Parent/Guardian Agreement

Parent/Guardian Enrollment Agreement

1. I hereby certify that I am the legal guardian/parent of the child being enrolled in the Big Brothers Big Sisters Program (BBBSI).

2. My child and I are willing to fully participate in the application and enrollment process as deemed appropriate by BBBSI.

3. I understand that BBBSI does not discriminate on the basis of race, ethnicity, age, sexual orientation, religion, or physical disability.

4. By signing below, I recognize that my application does not commit BBBSI to accept my child into the program or assign my child to a Big/Mentor.

5. I acknowledge and agree that if any documents and agreements completed as part of this process are executed by electronic signature, any such electronic signature shall be considered as an original signature for all purposes and shall have the same force and effect as an original signature.

6. I understand that the role of the Big is to act as a positive friend and role model for my child. I also understand that Bigs are volunteers and not trained in the field of mental health or social services.

7. I hereby agree that BBBSI may disclose any or all information obtained during the application process, in accordance with applicable privacy laws and solely for purposes related to the program’s operation and oversight.

8. I give my child’s school(s) and school district(s) permission to release my child’s grades, attendance and disciplinary records to BBBSI to be used solely for BBBSI’s statistical reporting purposes. In some cases BBBSI may use third party community partners and when required may share information with these service providers. BBBSI is committed to maintaining the confidentiality and security of your information and will take reasonable precautions to ensure that there will be no unauthorized release of your confidential information to others.

9. I agree to allow my child to complete questionnaires including but not limited to questions about peer relationships, feelings about school, grades, educational expectations, parental relationships and attitudes toward risky behaviors.

10. I agree to release, waive and hold harmless BBBSI and all of its officers, employees and agents from any liability, claims or actions of any kind that arise out of or are related to any loss, damage, or injury that may be sustained by me, my child or any of our other family members in attendance during our involvement in the BBBSI program or any of its sponsored activities. 
*By entering the following information, you are electronically signing this agreement as the legal parent/guardian of this child. 

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, and basic biographical information in, on, or in connection with any advertising, publicity, marketing, or printed or electronic media, of any type, throughout the world at any time by Big Brothers Big Sisters of America, BBBSI, and any of their affiliates, successors, partners, sponsors, donors, and any entities or persons with whom they conduct any public relations, marketing, or fund raising of any type 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.

Youth Safety Guidelines and Program Expectations for Parents/Guardians

  • BBBSI asks all families and volunteers to commit to a one-year match in the program.
  • Parents/Guardians and Littles matched in the program are REQUIRED to complete a monthly check-in call with BBBSI Staff to ensure that the match is developing a healthy relationship and to ensure that your child is safe in our program.
  • Parents/Guardians need to verify all plans that their child makes with their Big.
  • Parents/Guardians need to be present at home when a Big both picks up and drops off their child from outings. 
  • Match activities are expected to be free or low-cost, and BBBSI encourages Parents/Guardians and Bigs to split these costs equally when possible. 
  • Parents/Guardians should ask "safety questions" to their child before and after their match outings (e.g. how their match outing went, if they wore a seatbelt while driving, if anyone else went with them, what was the movie rated, etc.) 
  • Parents/Guardians, Bigs, and Match Support Specialists are partners in making a BBBSI match a positive and successful experience for all. BBBSI encourages Parents/Guardians to develop clear and positive communication with their child's Big, and respect the boundaries of everyone involved in the match. 
  • Matches who fulfill the 1-year commitment to one another and the agency is considered a successful match relationship with BBBSI.

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