BBBSSCW LogoYouth Application 

| Resume a previously saved form
Resume Later

In order to be able to resume this form later, please enter your email and choose a password.

Password must contain the following:
  • 12 Characters
  • 1 Uppercase letter
  • 1 Lowercase letter
  • 1 Number
  • 1 Special character
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. 
Hidden Fields
To look up the owner's email for notifications
For notifications
Youth Information
Note: Not all schools have a site based program.
Enter a date in the following format: mm/dd/yyyy

Hold CTRL+F to select multiple

4K-2036, K-2035, 1st-2034, 2nd-2033, 3rd-2032, 4th-2031, 5th-2030, 6th-2029, 7th-2028, 8th-2027, 9th-2026, 10th-2025, 11th--2024, 12th-2023
Guardian Information
Type NA if unemployed
Family Information
Physical Address

Emergency Contact
If we are unable to reach you in the event of an emergency, who is someone we could call who always knows how to reach you?
Please do not list yourself as emergency contact.

Additional Questions




Other Siblings and Relatives in the Program
Please choose this child's relationship to the following people:





























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.

Confidentiality Policy

Access to Confidential Records 

In order for the agency to provide professional services to clients, it is necessary for volunteers, clients and  parent/guardians of clients to be asked to divulge extensive personal information about themselves and their families.  The agency respects the confidentiality of client and volunteer records and, with the exception of situations listed  below, shares information about clients and volunteers only among the agency professional staff. Volunteers, clients,  and parent/guardians have a right to confidentially applied to written records, video, film, pictures or use of your  name in agency publications without your prior consent.  

All records are considered the property of the agency and not the agency workers or clients or volunteers themselves.  In order to provide a service which is in the best interest of the children served by the program, information from  outside sources, including confidential references must be assessed along with information gained from the clients or  volunteers themselves. Records are not available for review by the client or volunteers. Clients and volunteers shall be  provided, at the time of application, a copy of this statement on confidentiality along with the exceptions which define  the limits of confidentiality. Clients and volunteers shall sign a statement that he/she has read and understands the  agency policy on confidentiality and agrees to program participation under the guidelines it sets forth. 

Limits of Confidentiality 

1. Information will be released to other individuals or organizations only upon presentation of an authorized “consent  to release information” form appropriately signed by the client or volunteer.  

2. Identifying information regarding clients and volunteers may be used in agency publications or promotional  materials if the client or volunteer has given permission.  

3. For purposes of program evaluation, audit or accreditation and with the prior approval of the Board of Directors,  certain outside bodies such as Big Brothers/Big Sisters of America may have access to client and volunteer records.  These outside organizations shall be required to respect the agency policy on confidentiality. Outside parties shall be  required to use information only for the purpose (s) stated in the approval action of the Board of Directors. Known  violations of agency confidentiality policy will be reported to the supervisor of the individual involved and appropriate  disciplinary action shall be requested. 

4. Members of the Board of Directors have access to client files only upon authorization by formal motion of the  Board of Directors. The motion shall state who shall be authorized to review records, the specific purpose for such  review and the period of time during which access shall be granted. Members shall be required to comply with the  agency policies on confidentiality and may use the information only for the purpose stated by the approved action of  the Board of Directors. Known violations shall be reported to the Board President. A violation of the agency’s  confidentiality policy by a Board member shall constitute adequate cause for removal from office.  

5. Information shall only be provided to law enforcement officials or the court pursuant to a valid and enforceable  subpoena.  

6. Information shall be provided to an agency’s legal counsel in the event of litigation or potential litigation involving  the agency. Such information is considered privileged information and its confidentiality is protected by law.  

7. State law mandates that suspected child abuse be reported to the appropriate authorities, the Department of Social  Services. All workers are responsible for staying abreast of such reporting requirements of their respective jurisdiction  and shall always comply with mandated procedures.  

8. If an agency worker receives information indicating that a client or volunteer may be dangerous to himself/herself  or to others, necessary steps may be taken to protect the appropriate party. This may include a medical referral or a  report to the local law enforcement authorities. I have read and understand the above document which states the  agency policy with respect to confidentiality of client and volunteer records. I agree to program participation under  the conditions it set forth. 


Parent Permission

By checking the box below and providing my signature at the end of this form, I give permission:

  • For my child to participate in the Big Brothers Big Sisters Program;
  • For the volunteer matched with my child, who has been screened and approved by Big Brothers Big Sisters, to personally interact with and transport my child to events and match activities, if applicable and allowed by program type;
  • For the school district (listed below) to provide social and academic information about my child to Big Brothers Big Sisters (e.g., report cards, behavior reports, BBBSSCW supplemental forms);
  • 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;
  • To have my child talk with a Big Brothers Big Sisters staff person about personal safety;
  • 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 and with exceptions noted.  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 South Central Wisconsin (BBBSSCW) 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 BBBSSCW, 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.

Save my progress and resume later | Resume a previously saved form