High Risk Waiver

This form is for Parent/Guardians to complete for a youth who is matched with a Big in our Community-based program.

This form is required for any activity that you would sign a release form for if it was offered by a business. Common examples are:

Boating
Horseback riding
Rock climbing
Trampoline park
Kayaking

If your match is going to do any activity that could be considered high risk, please complete this form each time before the outing.

After you complete this form, it will be sent to the Big and your BBBS Match Support Specialist automatically.

Please contact your Match Support Specialist or our Program Director, Moriah Candler, if you have any questions regarding this form.

Contact Information

Parent/Guardian First Name

Nombre

Parent/Guardian Last Name

Apellido

Parent/Guardian Email

Correo electrónico (If you do not have an email address, please put swwabigs.program@swwabigs.org)

Youth's First Name:

Youth's Last Name

Youth's Date of Birth (Enter as: MM/DD/YYYY)

Fecha de nacimiento

Big's First Name:

Big's Last Name:

Big's Email

Correo electrónico (If you do not have an email address, please put swwabigs.program@swwabigs.org)

Notifications Email (hidden)

Consent

Activity:

Location:

I acknowledge the possible risk inherent to such an activity, and hereby release the volunteer Big Brother/Sister and Big Brothers Big Sisters of Southwest Washington, its members, directors, staff and/or supportive groups from all liability so long as such injury is not caused intentionally by any of the above.

YesNo

Contact Information