Enroll a Little: Youth Application

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





Enter a date in the following format: mm/dd/yyyy






Hold CTRL+F to select multiple



This is the year the youth will graduate.




Program Preference


Guardian Information





















Type NA if unemployed







Family Information



















Physical Address




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



Please choose this child's relationship to the following people:

Additional Questions



Child Assesment










Counselor/Therapist Contact Information






Other Siblings and Relatives in the Program












Parent/Guardian Authorization and Release

By checking the box below and providing my signature at the end of this form, I give permission:
  1. For my child to participate in the Big Brothers Big Sisters Program;
  2. 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;
  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 Mercer 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 [Agency Name], 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.

I give consent for my child to participate in an interview with BBBS staff focusing on school, home life, personal interests, and personal safety. I understand that this interview is conducted in order for BBBS staff to explain the program to my child and to assess my child for a compatible Big Brother/Big Sister. For SchoolBased matches, I give consent to Big Brothers Big Sisters of Mercer County, Inc. and to my child’s school to discuss my child’s social, academic, and behavioral information. The School Counselor or another school representative may be present when my child meets with BBBS staff.

COPPA Parental Consent Form

Notice to Parents In compliance with the Children’s Online Privacy Protection Act (COPPA), parents (or legal guardians) of children under 13 years of age must consent to collections, uses and disclosures of the personal information of their children collected by Big Brothers Big Sisters of Mercer County on Big Brothers Big Sisters of Mercer County and NATIONAL websites, including mercerbbbs.org, bbbs.org, MatchConnect, bbbsa.force.com, forms.bbbs.org and formstack.io. Big Brothers Big Sisters of Mercer County's COPPA statement is incorporated in the website Privacy Policy here: https://mercerbbbs.org/privacy-policy. Big Brothers and Big Sisters of Mercer County  may have collected your online contact information from your child, as well as the name of the child or the parent, in order to obtain your consent. Your permission is required for the collection, use, or disclosure of your child’s personal information. We will not grant your child access to any BBBS website account unless you provide us with permission. BBBS website accounts provide access to BBBS content, materials, and resources relating to BBBS programs and activities, including information pertaining to [MATCHES ETC.] 

You may revoke your consent at any time to refuse further collection and use of your child’s information. If you desire to revoke this consent, please contact our agency at jmolnar@mercerbbbs.org.

Confidentiality Policy

In order for Big Brothers Big Sisters of Mercer County to provide a responsible and professional service to clients it is necessary for volunteers, clients & parents or guardians of clients to be asked to divulge extensive personal information about themselves and their families. This information is collected during an interview and is used to create a profile of the applicant. This profile will be used by the agency to best match you with a Big Brother/Big Sister. A similar profile of the adult volunteer will be discussed with you to insure that your desires will be respected.


Relevant information shall be provided to the parties involved, however, the name or names of the parties described shall be kept confidential before a match is made. Any party has a right to refuse to enter into the match based upon the information so

communicated, and the agency is not obligated to assign or actively seek to assign, him/her a Big Brother/Big Sister. In the event of denial to participate in the program the reason for denial need not be given.


All records (including written, video, file, picture or use of prospective client or prospective volunteer’s name in agency publications) are considered the property of the agency and not the agency workers or clients or volunteers themselves. In order to provide aservice 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 clients or volunteers. Records are kept at the Big \ Brothers Big Sisters agency in areas that are only accessible to the agency’sstaff and aren’t available for review by the clients, parents and/or volunteers.


The agency respects the confidentiality of clients & volunteer records and shares information about clients and volunteers only among the agency professional staff with the exception of situations listed below:

1. Information will be released to other individuals or organizations only upon written permission of the parent 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 thepurpose(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 purposes stated by the approved action of the Board of Directors. Known 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 courts 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 law protects its confidentiality. 


7. New Jersey State Law mandates that suspected child abuse be reported to the appropriate authorities (Division of Youth and Family Services). All workers are responsible for staying abreast of such reporting requirements and shall always comply with mandated procedures. 


8. If an agency worker receives information indicating that a client or volunteer may be dangerous to him or herself or to others, necessary steps may be taken to protect the appropriate party. This may include a medical referral or report to the local law enforcement authorities

Contact Information