LITTLE ENROLLMENT FORM FOR COMMUNITY PARTNERS

Let's get started

Thank you for your interest in referring a child into the Big Brothers Big Sisters of Oklahoma

What is your relationship to the youth?

What is your name?

Which BBBS office is closest to your location?

Partners

In your area, we are currently partnered with Memorial Park Boys and Girls Club and Midwest City Elementary School.

Partners

In your area, we are currently partnered with Kendall Whittier Elementary School.

Teacher/Counselor Referral

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.

Youth Information

First Name

Middle Name

Last Name

Birthdate

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

Child's Gender

Child's Race/Ethnicity

American Indian or Alaska Native	Asian
Black or African American	Hispanic
Pacific Islander	White or Caucasian
Other	Prefer not to say

Tribal Affiliations

Child's School

Graduation Year

This is the year the youth will graduate.

Teacher's name

Guardian Information

Guardian Contact ID

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian phone:

Personal Email

Guardian's Relationship to Youth

Consent

Have you spoken with the child's guardian about the child's participation in the BBBS program?

YesNo

Does the parent/guardian approve?

YesNo

Contact Information