DINO (Dabble in New Opportunities) Youth Application

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HIDDEN FIELDS






DINO INFO 
We are proud to launch DINO – Dabble In New Opportunities! DINO is a new, completely FREE program open to all youth in Island County to provide fresh experiences, meet mentors, and have fun! This program is open to ALL youth aged 6-17 in Island County, not just those already enrolled in or interested in our traditional programs.

Exciting youth activities without barriers; no fees, no new equipment, no uniforms! All experiences will come fully furnished with all the tools you need to be involved; including transportation for many events.

We will be partnering with the Sno-Isles Library, Island County School Systems, The Center of Oak Harbor, and so many others to provide experiences in horseback riding, sailing, camp, fishing, art, gaming, sports, cooking, dance, and SO MUCH MORE.

Additional Waivers may be required for some activities and experiences. 
Non-Discrimination Policy
Thank you for your interest in Big Brothers Big Sisters! 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. 

Youth Information



Concatenated from First + Last








This is the year the youth will graduate.


Parent/Guardian Information





The parent/guardian is this child's
I prefer to be contacted by
Family Information










Family Military Experience




Emergency Contact, if parent not available


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Health Information
Doctor & Medications



Health and Well-Being
Does your child experience any of the following?







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Matching Activity Preferences
The following questions are designed to help us make the best, most successful match for you and your potential Big. We do this by exploring your preferences in a match!  Please mark the option that best describes how you feel for each activity listed below and include anything we might have missed!









































Parent Consent and Program Policies

Photo Release
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, Big Brothers Big Sisters of Island County, 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 such use.

Photo Release to School 
I hereby give permission to allow Big Brothers Big Sisters of Island County to give my child’s name and/or photographs, etc. to the School District for publication in the School Yearbook and other school promotional posters, pictures, or videos.

Digital Technology and Social Networking Policy

The purpose of this policy is to outline guidelines for recommended and appropriate uses of Digital Technology and Social Media for use by matches, including Bigs, Parent/Guardians and Littles that will ensure Confidentiality, Privacy and Youth Safety for all participants of the Agency.

 

Bigs and Littles in the Community-Based program are permitted to connect via social media with the following guidelines in mind. Mentors in the Community-Based program are also encouraged to share positive stories about Big Brothers Big Sisters and their Littles while following these ground rules.

BBBSIC recognizes that online social networking (Facebook, Instagram, SnapChat, Twitter, LinkedIn, Blogs, etc.) are very popular communications tools and that many of our Big Brothers/Sisters and Little Brothers/Sisters use these media. In general, personal use of social networking sites is typically for communications between peers, including friends and family.  BBBS wants to reiterate that your relationship with your Little is that of a mentor in addition to a friend. Thus, not all social networking sites/uses are designed to support mentoring relationships.  Please proceed thoughtfully when inviting or accepting an invitation from your Big/Little/Little’s Parent/Guardian to a social networking site.  If you have any doubts, please contact Agency Staff and/or postpone your invitation or acceptance.  If you choose to participate in social media with your Big/Little/Little’s Parent/Guardian, you must adhere to the following guidelines regarding any postings related to your match or affiliation with BBBS: 

 

1.     Do not participate in any online communication with/about your Little unless you have discussed this with the Parent/Guardian and the Match Coordinator and have received their approval.

2.     Give the Parent/Guardian and Agency Staff your user handle/website address and, when possible, link your page to the Agency page on that site so that we can follow along with your postings.  We are active on social media sites, such as Facebook, Twitter and Instagram.

3.     Never post any pictures of your Little online. 

4.     Never post the last name of your Little, their Parent/Guardian or BBBS Staff.

5.     Never post ANY contact information or identifying information about your Little (i.e. home address, school, where parent works, etc.). 

6.     Never post anything that could be perceived as judgmental or offensive to your Little or their family.

7.     Honor confidentiality guidelines within your match; be cautious when posting detailed information about conversations with your Little, their Parent/Guardian or with BBBS Staff. Posting generalized information or status updates is typically appropriate, but lengthier postings or blogs containing in-depth information should be approved by the Parent/Guardian and by BBBS prior to posting.

8.     Be aware of postings on your page that may be inappropriate for minors, even if not BBBS-related. Know that as a BBBS Volunteer you are a role model at all times. Please ensure that all contents are appropriate and youth-friendly, in case your Little or their family were to read your social networking page. If the social networking site allows, create a separate group for your Little, their Parent/Guardian and BBBS Staff that limits your Little’s access to your general or universal postings. 

9.     When in doubt about whether something is appropriate to post, consult with Agency Staff prior to posting.

10.  Most social media platforms have requirements that minors be age 13 before using the service.  Mentors should not connect with youth under the age of 13 on social media. 

In the event a Big does NOT want to engage or connect with Match via social media, staff will recommend that Big ensure their page settings are set to private, so that only approved people can view online content.


Parent & Youth Protection Training

I acknowledge that I am responsible for the information contained in the orientation and do hereby agree to follow all of the guidelines outlined.

 

I acknowledge that my child and I will participate in Safety Awareness Training with a member of the Big Brothers Big Sisters of Island County staff, or through the Learning Exchange.  I further acknowledge my role in protecting my child from abuse.


Parent/Guardian Consent

BY SIGNING BELOW I GIVE PERMISSION:

1.     For my child to participate in the Big Brothers Big Sisters of Island County Programs, which include both the DINO program and the one-to-one mentoring programs;

2.     For the volunteer matched with my child,  as well as staff and the identified designees who have been screened and approved by Big Brothers Big Sisters

 to personally interact with and transport my child to events, activities 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 Island County 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 Island County, 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.




Parent/Guardian Consent

BY SIGNING BELOW I GIVE PERMISSION:

1.        For my child to participate in the DINO Program presented by Big Brothers Big Sisters of Island County; 

2.       For the staff of Big Brothers Big Sisters and the identified designees who have been screened and approved by Big Brothers Big Sisters, to personally interact with and transport my child to events and activities, if applicable;

3.     To have my child 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. 

 

 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 mentors, instructors and guides who are assisting and leading the DINO program. 

 

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 Island County 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 Island County, 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.