High School Volunteer Application

Hidden Fields
Basic Information







Contact Information
Additional Information

Volunteer Statement of Understanding, Pledge, and Policy

I, understand, that if I am accepted as a Mentor, I agree to abide by the rules and regulations of the Big Brothers Big Sisters of Broward, Inc. “Bigs in School” (BIGS) site-based level of service. I understand that the program involves spending a minimum of one hour each week at the assigned site with my mentee. Further, I understand that I will attend an orientation session, be involved in training during the year, communicate with the case manager regularly during this period and provide adequate notice if I am unable to meet my time commitments. I also agree to adhere to the rules of the agency I will be volunteering for and abide by the procedures including any record keeping required and maintain the confidentiality of agency and client information. I understand that the Big Brothers Big Sisters of Broward "Bigs in Schools” project and relationships established, take place within the confines of a school or site only. It is not part of any relationships established between mentor/mentee and family members beyond the school or site hours. I understand that I am not to contact my mentee outside of the project except for phone calls.


Big Brothers Big Sisters is a social service program designed to help children who have shown a need for an additional supportive relationship. While the program is an interfaith and interracial one, the desire of the child's parent/guardian are respected in the selection of a volunteer. Confidentiality is honored for all clients and volunteers applying to our agency. Relevant information shall be provided to both parties prior to making a match. However, names and identifying factors shall be withheld. Any party has the right to refuse to enter into a match based upon the information so communicated. The information contained in my application is true, accurate and complete and I have a duty to update my information form with the most current information available during the time my application is being processed.

Pre-Interview Questionnaire

Prior to your interview, please answer the questions below. The information you provide will also help us make a better match for you and assure we can support you during your involvement with our program. Please note that you will have an opportunity to discuss these questions and your responses more thoroughly during your interview.  

Guidelines and Ground Rules for Volunteers                                                                      

I understand that:


1) The references I listed may be contacted by mail, telephone, or email if needed.


2) The information I provided will be used to conduct a background check if 18 and over, to include criminal background check, and other records where required by local, state, or federal law for volunteers working with youth.


3) The BBBS agency is not obligated to match me with a youth.


4) I am obligated to immediately notify the Agency of any changes in information contained in this application.


5) If I am not accepted as a volunteer, the Agency is not required to disclose the reasons for non-acceptance.

Parent/Guardian Permission or Self Release (If over 18 years of age)

Media Consent and Release:


I irrevocably consent to any and all uses and displays of my name, image, likeness, appearance, basic biographical information, audio/video recordings, writings, artwork, and the like, in original form or in modified form, in whole or in part, in, on, or in connection with merchandise, advertising, publicity, marketing, fundraising, and the like, in printed or electronic media, of any type, throughout the world at any time by Big Brothers Big Sisters of America and Big Brothers Big Sisters of Broward in their sole discretion, and by any of their affiliates, successors, partners, sponsors, donors, any entities or persons with whom they conduct any public relations, marketing, or fund raising of any type, and any other authorized third parties, without further consent from me, without any royalty, payment, or other compensation to me, and with the release and waiver of any claims, actions, damages, losses, costs, expenses and liability of any kind arising from any such use (the “Released Material”). In consideration of the mutual promises made herein, and for other good and valuable consideration, the receipt and sufficiency of which I hereby acknowledge, I hereby grant to BBBSA and its affiliates the right to use the Released Material as BBBSA and/or its affiliates may desire, in all media now existing or hereafter created and in all variations and forms including, but not limited to, internal or external publications or productions, informational or recruitment materials, marketing materials, fundraising materials, televised photography and/or recordings, advertisements, Public Service Announcements, and/or online and social media sites. The use of this information shall be at the sole discretion of BBBSA and/or its affiliates.

I further grant to BBBSA and its affiliates the absolute right to use the Released Material in whole or in part, alone or in conjunction with any other image, name, writings or reproduction, in color or otherwise, for art, advertising, business, trade, or any other lawful purpose whatsoever, in perpetuity throughout the world. I understand and agree that all materials created by BBBSA and/or its affiliates that use the Released Materials are the property of and are owned by BBBSA, and that I cannot authorize their use by any other party.  I further understand that BBBSA may authorize their use by a third party. I hereby irrevocably transfer and assign to BBBSA my entire right, title and interest, if any, in and to the Released Materials and all copyrights in the Released Materials arising in any jurisdiction throughout the world, including the right to register and sue to enforce such copyrights against infringers. I acknowledge and agree that I have no right to review or approve the Released Materials before they are used by BBBSA and/or its affiliates, and that BBBSA has no liability to me for any editing or alteration of the Released Materials or for any distortion or other effects resulting from BBBSA’s and/or its affiliates’ editing, alteration or use of the Released Materials.  BBBSA has no obligation to use the Released Materials or to exercise any rights given by this Consent and Release Form. I hereby release BBBSA and its affiliates, employees, and agents, as well as any partner companies, from all claims, demands or liabilities and related financial costs that I may now or hereafter have arising in connection with BBBSA’s exercise of the rights hereby granted, and/or with the appearance or the Released Materials in any publication or production. These include, without limitation, claims for compensation, defamation, or invasion of privacy, or other infringements or violations of personal or property rights of any sort whatsoever.

Consent to Request/Release Information


I hereby authorize BBBS to request, obtain and release information and/or records concerning academics, psychological evaluations, or diagnostic evaluations, including Individual Education Plans and report cards. This authorization shall be effective and continually in force, to the extent permitted by law, from the date of this authorization until revoked by the Parent/Guardian with written notice or a Successor Authorization, provided by BBBS is executed. I agree to provide to BBBS of Broward copies of my most recent child’s/my Report Card upon acceptance into their program and also at the end of each term of the academic year. I hereby make formal application to BIG BROTHERS BIG SISTERS OF BROWARD, INC., a non-profit Florida Corporation to make available the services of BBBS to my child/self, and if possible, assign to him/her/me a competent volunteer. I hereby release BIG BROTHERS BIG SISTERS OF BROWARD, INC. of all responsibilities in connection therein.


I hereby understand that BBBS of Broward, Inc. may disclose information about my child/self which is contained in this application, is learned through interview or otherwise, to only a volunteer who is being considered as a Big Brother/Big Sister for my child/self, and authorize the same

References

Please provide a parent/guardian reference below. 
Teacher/Counselor Reference
Parent/Guardian Reference

Contact Information