CBM Youth Application

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Non-Discrimination Policy
BBBSMM will not discriminate on the basis of race, ethnicity, color, religion, national origin, gender, gender identity, gender expression, citizenship status, marital status, sexual orientation, age, veteran status or disability with respect to employment, volunteer, youth, parent/guardian or non-mentoring volunteer participation or the provision of services.

 * In all steps of enrollment, matching and support, BBBSMM will allow for reasonable accommodations for applicants and staff in alignment with the Americans with Disabilities Act (ADA).*
Hidden Fields
To look up the owner's email for notifications
For notifications
Important Information
REQUIRED: This form MUST be signed (e-signature) by the parent or legal guardian of the child being enrolled.

PLEASE NOTE: If this form is being completed with the assistance of another individual (not the parent or legal guardian) it is critical that the parent or legal guardian be present during it's completion to review all information provided and to review all conditions of consent included within this application.
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.
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?

Additional Questions




















Parent/Guardian Agreement

By checking below and signing this application 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 transport my child to events and match activities; 
3. For the school to provide social, academic, demographic and contact information about my child to Big Brothers Big Sisters (e.g. report cards, behavior reports, parent contact information etc); 
4. To have my child participate in an in-take interview conducted by Big Brothers Big Sisters staff and complete questionnaires throughout his/her time in the program containing questions about school, home life, and personal interests;
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; 
7. For my child to use TheApp, the secure and supervised online messaging platform for BBBS matches and BBBS staff. 

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, must 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 do hereby release the organization and its employees, agents, members, volunteers and all other persons on its behalf from any and all liability for any damage or injury which such child might sustain while participating 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 his/her guardian. 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 
Medical Release
Media Release

Confidentiality Policy

I understand that all personal information will remain confidential and is used by agency staff or Board for the purposes of creating and supporting a quality match. Confidential information concerning the potential participants deemed pertinent by staff will be shared with the Big and parent/guardians of a prospectives Little. 
Supporting Information
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Contact Information