High School Volunteer Application

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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.

PLEASE REVIEW THIS DOCUMENT COMPLETELY AND CAREFULLY.  It includes a release of liability and waiver of legal rights on behalf of yourself and your minor child/ward, including a waiver of the right to sue certain parties. Do not agree to this document unless you have read and understand it in its entirety. By signing this document, you acknowledge that you have both read and understood the text presented to you. When you sign below, you understand and agree that participating in Big Brothers Big Sisters of Broward County’s programs, including sponsored events and related activities, carry certain inherent dangers and risks which may or may not be readily foreseeable, including, without limitation, personal injury, property damage or death. You and your minor child/ward’s ability to participate in these programs and events are subject to your agreement to the terms of this Release of Liability and Waiver, and by signing this agreement, you accept and agree to the terms stated herein on behalf of yourself and your minor child/ward, as designated below, including the release of liability and waiver of legal rights provisions. You have the right to refuse to sign this agreement, and Big Brothers Big Sisters of Broward County and any other of the released parties have the right to refuse to let you and/or the child participate if you do not sign this agreement.  I wish for the minor child/ward identified below (referred to herein as the "Child") and myself (if applicable) to participate in Big Brothers Big Sisters of Broward County’s (referred to herein as “BBBS”) programs as well as any and all events hosted by, organized by or in any way presented to myself and the Child by BBBS.  I understand that mine and/or the Child’s participation in any BBBS program and/or event, which may include water activities, physical activities and/or activities that are inherently dangerous, is voluntary and it is my responsibility to take proper precautions to minimize the risk of injury to myself, the Child and others. 

Therefore, for good and valuable consideration, including the right to participate in BBBS’ programs and events, the receipt and sufficiency of which is hereby acknowledged, I agree on behalf of myself and the Child as to the conditions stated in this Release of Liability and Waiver (referred to herein as the “Release”).


Release, Indemnification and Waiver. As consideration for myself (as applicable) and the Child being permitted to participate in BBBS’ programs and/or events, I, the undersigned, on behalf of myself and the Child, hereby irrevocably and unconditionally release, discharge, hold harmless, indemnify, and covenant not to sue BBBS, its employees, directors, members, board members, sponsors, partners, volunteers, agents and/or the Child’s assigned Big Brother/Sister (collectively, the “Released Parties”) of and from any and all liabilities, injuries, illness, disability, death, losses, claims, damages, demands, rights of action or causes of action, including those arising out of or related to potential exposure to the novel coronavirus COVID-19, present or future, known or unknown, foreseen or unforeseen, arising out of or in any manner resulting from my or the Child’s presence at or participation in any BBBS program and/or event, including events and physical activities that are inherently dangerous or carry risks of injury or death to person or property, as well as outings with the Child’s Big Brother/Sister including without limitation driving with the Child’s Big Brother/Sister, whether caused in whole or in part by the negligence, acts, omissions, carelessness, or other conduct of the Released Parties (collectively, “Claims”). This Release shall be binding upon my and the Child’s heirs, executors, administrators and assigns. 


I further acknowledge that I may be asked to sign additional waivers or releases of liability in connection with specific BBBS events that I or the Child participate in, and I acknowledge and agree that any subsequent waiver of liability or release signed in connection with a specific BBBS event does not supersede nor replace this Release but is instead in addition to this Release. I further acknowledge and agree that this Release covers and applies to any and all events and/or programs I or the Child participates in through BBBS and that no additional waiver of liability or release is needed.  


Assumption of Risk and Ability to Participate. I understand that, even with adherence to reasonable safety practices, there exists a risk of injury to those who participate in a BBBS program or event.  I acknowledge that such injuries could be catastrophic, including paralysis and death. I understand that some of these risks are outlined herein, but there may be other, unknown risks that are an inevitable part of participating in BBBS programs and/or events. I understand that the Child will likely be driven by the Child’s Big Brother/Sister which transportation also carries inherent risks. I further understand that neither I, nor the Child, should participate in any BBBS program or event unless we are physically and medically able to do so and agree and acknowledge that it is my sole responsibility to determine my (as applicable) and the Child’s physical fitness and our ability to engage in a BBBS program and/or event. I understand that it is my responsibility to consult with my physician or the Child’s concerning any injury, illness, or medical condition that arises during the course of any BBBS program or event and after I execute this Release. Further, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that the Child or I may be exposed to or infected by COVID-19 by attending and participating in BBBS programs or events and that such exposure or infection may result in personal injury, illness, disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at a BBBS program or event may result from the actions, omissions, or negligence of myself and others, including, but not limited to, the Released Parties and program participants and their families. I knowingly, freely and voluntarily accept and agree to assume all of the foregoing risks and accept sole responsibility for any claims that I or the Child may experience or incur in connection with my or the Child’s attendance at or participation in a BBBS program or event.  My, and the Child’s access to, use of, or participation in a BBBS program or event is completely voluntary, and I, on behalf of myself and the Child, including the Child’s, assume all risk associated therewith, whether the risks are foreseeable or not foreseeable. IN EXCHANGE FOR BBBS ALLOWING ME AND THE CHILD TO PARTICIPATE IN ANY PROGRAM, ACTIVITY, OR EVENT ASSOCIATED WITH BBBS, I AGREE THAT MYSELF AND THE CHILD ON BEHALF OF WHICH I AM SIGNING THIS RELEASE (SUBJECT TO FLORIDA LAW), WAIVE AND FOREVER RELEASE THE RELEASED PARTIES FROM LIABILITY FOR ANY CLAIMS. IN OTHER WORDS, I ASSUME ALL THE RISKS AND ALL THE RESPONSIBILITY FOR MY OWN WELL¬BEING AND THE WELLBEING OF THE CHILD. This Assumption of Risk shall be binding upon my and the Child’s heirs, executors, administrators and assigns.

 

Treatment. I understand and agree that I will be responsible for the care and treatment of the Child in the event the Child sustains an injury during or as a result of the Child’s participation in any BBBS program or event.  I hereby acknowledge and understand that neither BBBS nor any other Released Party has any obligation or duty to provide medical treatment for the Child in case of injury. Notwithstanding such absence of duty, as parent or legal guardian of the Child, I hereby give my consent to the Released Parties to seek, obtain, and provide emergency medical treatment for the Child in case of injury that occurs while participating in a BBBS program or event. This care may be given under whatever conditions are necessary to preserve life, limb, or wellbeing of the Child. I understand that such treatment will be sought and provided if, in the sole opinion of the Released Parties, medical attention is prudent or needed and I hereby agree to pay all costs associated with such medical care. I further understand that reasonable efforts may be made to contact me before providing such treatment, however, that the treatment will be sought and provided to the Child regardless of whether I have been contacted.


Disclaimer of Warranties. THE RELEASED PARTIES MAKE NO WARRANTY THAT ANY BBBS PROGRAM OR EVENT WILL BE SAFE, SECURE OR ERROR FREE AND EXPRESSLY DISCLAIM ALL WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING WITHOUT LIMITATION ANY WARRANTY OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE OR NON-INFRINGEMENT. 


Legal Authority. I hereby represent and warrant that I am at least 18 years of age and of sound mind and body, and I am legally capable of giving this release on my behalf and on behalf of the Child, that I have the legal authority to agree to this Release on the Child's behalf. By signing below, I acknowledge that I FULLY UNDERSTAND AND AGREE to the terms of this Release and that this Release will apply to me and the Child, and to our heirs, personal representatives, and assigns and that I have the authority to bind the Child to the terms stated herein. 


Applicable Law; Consent to Jurisdiction and Venue. I hereby agree that the laws of the State of Florida, without regard to the conflict of laws principles thereof, will apply to any and all disputes or claims relating in any way to this Release and my participation in any BBBS program or event.  I agree that the exclusive jurisdiction for such disputes and claims shall lie exclusively in Broward County, Florida and I agree and expressly consent to the exercise of personal jurisdiction in such courts over myself and the Child. 


Jury Trial Waiver. I EXPRESSLY AND IRREVOCABLY WAIVE ANY RIGHT TO TRIAL BY JURY IN ANY ACTION ARISING OUT OF OR RELATING TO THIS RELEASE OR THE CHILD’S AND/OR MY PARTICIPTATION IN ANY BBBS PROGRAM OR EVENT.

I HEREBY AFFIRM THAT I HAVE READ THIS RELEASE, AND THAT I FULLY UNDERSTAND ITS TERMS. I FURTHER AFFIRM MY UNDERSTANDING THAT, BY SIGNING THIS RELEASE, I AM GIVING UP SUBSTANTIAL RIGHTS ON BEHALF OF MYSELF AND THE CHILD, INCLUDING THE RIGHT TO SUE. I ACKNOWLEDGE THAT I AM ASSENTING TO THIS RELEASE FREELY AND VOLUNTARILY, AND THAT BY SIGNING I INTEND FOR MYSELF AND THE CHILD TO BE BOUND BY THIS RELEASE TO THE FULLEST EXTENT ALLOWED BY LAW. 

Severability. 


I understand that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Florida and agree that if any portion of this Release is invalid, the remainder will continue in full legal force and effect.

References

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

Contact Information