Big Brothers Big Sisters of Miami          Youth Enrollment

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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.
Guardian Information
Type NA if unemployed
Family Information

Physical Address
Emergency Contact #1
If we are unable to reach you, who is someone we could call who always knows how to reach you?
Emergency Contact #2
If we are unable to reach you, who is someone else we could call who always knows how to reach you?

Additional Questions


Littles are matched with a Big (mentor) in a one-to-one mentoring relationship. Littles and Bigs spend time together at least twice a month, for approximately four hours each time. Bigs coordinate outings with the Littles' parent/guardian, choosing activities both enjoy, such as playing board games, visiting a museum, playing or watching sports, going fishing, or any other child-safe, parent-approved activity. Littles benefit from having a positive role model and participating in enriching experiences.

Littles are paired with mentors from companies and organizations that volunteer as a group. High school students participate regularly throughout the school year. Employee volunteers are matched with Littles who either:

  •      Are transported to the worksite for four hours monthly during the school year. Site visits include a college and career readiness workshop and one-on-one time for job shadowing and mentoring.
  • Participate in presentations twice a month during the school year. These presentations help Bigs and Littles complete a post-secondary success project together. For example, after a presentation on elevator pitches, the Big and Little will draft and practice an elevator pitch for the Little.

Students gain valuable exposure to workplace practices and career and scholarship opportunities.

Littles are matched with a Big (mentor) at a designated school and meet for approximately an hour each week throughout the school year. Visits take place at school or at the Little’s after-school program. Activities may include playing educational games, reading together, talking about life, or any other activity available at the program site. For in-person programming, Bigs and Littles are required to stay at the designated program site, either the Little’s school or after-school program, and may not leave site grounds for any reason.
The Group Engagement & Mentoring (GEMS) program at Big Brothers Big Sisters of Miami (BBBSM) offers enriching group activities and mentorship for Littles at our headquarters. In GEMS, participants engage in various activities with a consistent cohort, creating a strong sense of community. Each group is led by a BBBSM staff member, who provides guidance and support, along with community volunteers serving as additional mentors. The program helps Littles develop social skills, build relationships, and gain valuable experiences through fun and educational activities. GEMS fosters personal growth and resilience in a supportive environment, helping your child thrive.
Littles are matched with a Big (mentor) at a nearby middle or high school and meet at school at least twice monthly, ideally weekly. Students have been awarded a college scholarship, and mentoring helps them stay on track for an on-time high school graduation and enrollment in an institution of higher education. Activities include discussing ways to be successful in school and the workplace, talking about life goals, and completing activities from the Mentor Toolkit.



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.

Parent/Guardian Agreement

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 BBBS Miami 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 BBBS Miami, 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.

Photo Consent and Release Form

I,
legal parent or guardian of
("Minor Child"), irrevocably consent:
For myself and Minor Child to any and all uses and displays of my or Minor Child’s name, image, likeness, appearance, basic biographical information, audio/video recordings, writings, artwork, and the like, in original form or in modified form, in whole or in part, in, on, or in connection with merchandise, advertising, publicity, marketing, fundraising, and the like, in printed or electronic media, of any type, throughout the world at any time by Big Brothers Big Sisters of America and [BBBSA affiliate] in their sole discretion, and by any of their affiliates, successors, partners, sponsors, donors, any entities or persons with whom they conduct any public relations, marketing, or fund raising of any type, and any other authorized third parties, without further consent from me or Minor Child, without any royalty, payment, or other compensation to me or Minor Child, and with the release and waiver of any claims, actions, damages, losses, costs, expenses and liability of any kind arising from any such use (the “Released Material”). In consideration of the mutual promises made herein, and for other good and valuable consideration, the receipt and sufficiency of which I hereby acknowledge, I hereby grant to BBBSA and its affiliates the right to use the Released Material as BBBSA and/or its affiliates may desire, in all media now existing or hereafter created and in all variations and forms including, but not limited to, internal or external publications or productions, informational or recruitment materials, marketing materials, fundraising materials, televised photography and/or recordings, advertisements, Public Service Announcements, and/or online and social media sites. The use of this information shall be at the sole discretion of BBBSA and/or its affiliates. I further grant to BBBSA and its affiliates the absolute right to use the Released Material in whole or in part, alone or in conjunction with any other image, name, writings or reproduction, in color or otherwise, for art, advertising, business, trade, or any other lawful purpose whatsoever, in perpetuity throughout the world. I understand and agree that all materials created by BBBSA and/or its affiliates that use the Released Materials are the property of and are owned by BBBSA, and that I cannot authorize their use by any other party. I further understand that BBBSA may authorize their use by a third party. I hereby irrevocably transfer and assign to BBBSA my entire right, title and interest, if any, in and to the Released Materials and all copyrights in the Released Materials arising in any jurisdiction throughout the world, including the right to register and sue to enforce such copyrights against infringers. I acknowledge and agree that I have no right to review or approve the Released Materials before they are used by BBBSA and/or its affiliates, and that BBBSA has no liability to me or Minor Child for any editing or alteration of the Released Materials or for any distortion or other effects resulting from BBBSA’s and/or its affiliates’ editing, alteration or use of the Released Materials. BBBSA has no obligation to use the Released Materials or to exercise any rights given by this Consent and Release Form. I hereby release BBBSA and its affiliates, employees, and agents, as well as any partner companies, from all claims, demands or liabilities and related financial costs that I or Minor Child may now or hereafter have arising in connection with BBBSA’s exercise of the rights hereby granted, and/or with the appearance or the Released Materials in any publication or production. These include, without limitation, claims for compensation, defamation, or invasion of privacy, or other infringements or violations of personal or property rights of any sort whatsoever. 

 

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 BBBS Miami on BBBS Miami and NATIONAL websites, including bbbsmiami.org, bbbs.org, MatchConnect, bbbsa.force.com, forms.bbbs.org and formstack.io. 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. 

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 305-644-0066.

Medical Release

I authorize Big Brothers Big Sisters (BBBS) employees and/or BBBS volunteers to consent to such medical or surgical treatment as I deem necessary for my child in the event of an emergency, illness of my child, or accident involving my child. If possible under the circumstances, these medical services should be performed by the physician or facility listed below.
Authorization for Exchange of Confidential Information
I, hereby authorize the below agency(ies) and/or individual(s) to release any and all information relating to the child to Big Brothers Big Sisters of Miami, Inc. ("Agency"), including any psychiatry, psychological, academic, medical, and/or social information.
Doctor Office Information

Confidentiality Policy

In order for Big Brothers Big Sisters of Miami, Inc., (“Agency”) to provide a responsible and professional service to clients, it is necessary for clients, parents/guardians, and volunteers to divulge extensive personal information about themselves and their families. Additionally, the Agency collects information from outside sources, including confidential references, which become part of client, parent/guardian, or volunteer files. All records are the property of the Agency and are not property of any Agency employee, client, parent/guardian, or volunteer. Therefore, records are not available for review by clients, parents/guardians, or volunteers. The Agency respects the confidentiality of clients and volunteers and, with the exception of the situations listed below, shares collected information only among Agency staff who need to know the information to responsibly complete their job duties.

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 (i) the client’s parent/guardian when the information requested relates to the client, of (ii) the volunteer when the information requested relates to the 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 individuals or 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 Confidentiality Policy. 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’s Confidentiality Policy will be reported to the supervisor of the individual involved, or to the President, and appropriate disciplinary action shall be taken. 
  4. Members of the Board of Directors have access to client files for various reasons, including (i) program evaluation, audit and case planning, (ii) under circumstances that may adversely impact the Agency to evaluate the impact and the Agency’s response, and (iii) at the discretion of the Executive Committee of the Board of Directors and/or the Agency’s Management Team.
  5. Information shall be provided to (i) Agency legal counsel or any counsel selected by the Agency and/or (ii) the Agency’s insurance carrier in the event of litigation or potential litigation or at the discretion of the President and CEO or the Executive Committee of the Board of Directors for any matter involving the Agency. Such information provided to legal counsel is privileged information, and its confidentiality is protected by law.
  6. Information shall only be provided to law enforcement officials or the courts pursuant to a valid and enforceable subpoena.
  7. During the pre-matching process, information about the client and parent/guardian will be shared with the potential volunteer, and vice-versa. After a match has been created, information about the matched volunteer will be shared with the client and parent/guardian, and vice-versa.
  8. State law mandates that suspected child abuse be reported to the Florida Department of Children & Families. Agency workers shall comply with mandated procedures. 
  9. 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.

Youth Safety Guidelines and Grounds Rules for Parents/Guardians

My child and I have received orientation materials, as well as discussed them with BBBS staff, covering the following topics:

  • Description of BBBS agency mission, programs, benefits, and purpose of program (why we do the work we do)
  • Child/Youth eligibility criteria and commitment expectations, emphasizing the importance of parental involvement
  • Information regarding the enrollment process, including the agency’s right to accept or deny participants, or close a match at any time
  • Ground rules and program rules
  • What is match support and their role
  • The match closure process
  • Child safety: youth protection training, child abuse and mandatory reporting
  • Personal Safety for Children guidelines and procedures
  • Specific guidance about the role of a mentor

We understand that BBBS provides important child safety training for all participants. I received information related to child saety, including “Personal Safety for Children.” I understand that Child Safety is a top priority of BBBS, and that, when my child is paired, I will play an essential role in encouraging safety guidelines. We have been oriented on child abuse and mandatory reporting. I am prepared to comply with BBBS Child Safety ground rules.


We understand the role of a mentor and have been provided material that clearly defines a mentor’s role. We understand that the mentor is not a babysitter, spiritual advisor, teacher, disciplinarian, and/or financial provider.


We have been strongly encouraged to seek out additional child safety community resources and information whenever possible.

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