Youth Application Template

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

Site Based Facilitated is only offered in the following schools: Beaver Falls Central Elementary, New Brighton, Rochester, Freedom, South Side.
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




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 Big Brothers Big Sister of Beaver 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 Big Brothers Big Sisters of Beaver County, 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. 

 

Social Media Policy

At BBBS of Beaver County, we recognize that online platforms such as Facebook, Instagram, X (formerly Twitter), TikTok, LinkedIn, and blogs are widely used for communication and community engagement. We understand that many of our Bigs and Littles are active on these platforms. While social media can help foster friendships, we remind all volunteers that the primary nature of the Big-Little relationship is a mentoring one.

Because not all social media platforms are designed with youth mentoring in mind, we ask that volunteers approach digital interactions with caution and respect for boundaries. When in doubt, consult your Match Support Specialist before proceeding.

 

If you choose to engage with your Little or share content related to your match on social media, you must adhere to the following rules:

 

Consent and Communication

·       Always discuss digital interaction with the Little's parent/guardian before initiating or responding to messages or friend/follow requests.

·       Provide the parent/guardian with your social media handle and inform them of any interaction.

·       When possible, link your profile to BBBS of Beaver County's official page (especially on Facebook) so staff can remain aware of public posts involving BBBS.

Privacy and Safety

·       Do NOT post photos of your Little under any circumstances.

·       Do NOT share your Little’s last name, their parent/guardian’s name, or any contact or identifying information (e.g., address, school, workplace, etc.).

·       Do NOT tag your Little or their family in any posts.

Content and Conduct

·       Avoid sharing any content that could be perceived as judgmental, inappropriate, or offensive to your Little or their family.

·       Maintain confidentiality. Refrain from sharing private conversations or sensitive details about your match. General updates like “Excited for my outing with my Little this weekend!” are typically okay.

·       Act as a role model at all times. Avoid sharing posts, comments, memes, or photos that depict violence, drug/alcohol use, profanity, or other adult content.

When in Doubt

·       Always consult your Match Support Coordinator before posting anything that could fall into a gray area. If you're unsure, wait until you receive approval.


Noncompliance

Failure to follow this policy may result in disciplinary action, including termination of your match.


We encourage thoughtful and respectful use of social media to support healthy, safe mentoring relationships and uphold the mission and values of BBBS of Beaver County.

Confidentiality Policy

Big Brothers Big Sisters of Beaver County respects the confidentiality of clients and volunteer records and, with the exception of situations listed below, shares information about clients and volunteers only among agency staff.

All records are considered the property of the agency and not the agency workers or clients or volunteers themselves. Records are not available for review by clients or volunteers. Information will not be released except in the following circumstances:

1. Information will be released to other individuals or non-BBBS organizations only with the client or volunteers written consent.

2. Identifying information regarding clients and volunteers may be used in agency publications or promotional materials unless the client or volunteer requests otherwise.

3. For the purpose of program evaluation, audit, or accreditation, and with 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.

4. Members of the Board of Directors or evaluators appointed by the Board have access to client files upon authorization of the Board of Directors.

5. Information shall be provided to law enforcement officials or the courts pursuant to a valid and enforceable subpoena.

6. Information shall be provided to funders, fiscal agents, and/or partners.

7. Information shall be provided to an agency’s legal counsel in the event of litigation or potential litigation involving the agency.

8. State law mandates that suspected child abuse be reported to the appropriate authorities.

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

10. At the time the child or volunteer is considered as a match candidate, information is shared between the prospective match parties. The information about the volunteer may include items such as: age, sex, race, religion, interest, hobbies, marriage, family status, sexual orientation, living situation, etc. Information about a client may include such items as age, sex, race, religion, interest, hobbies, family situations, etc. 

Youth Safety Guidelines and Grounds Rules for Parents/Guardians

The safety your children is our number one priority – no exceptions. While our staff carefully screens each volunteer, we need your help to make sure the relationship is healthy and the volunteer is making good judgements about your child's safety on outings. Here’s how you can further promote safety:

·       Participate in planning and approve activities; if you are not comfortable with an activity that your Big suggests, you are encouraged to not approve. Talk to your BBBS match support staff when you have questions.

·       When your Big takes your child out, the Big should always stay with him or her and not leave them alone or with someone else.

·       Your child's Big should not use alcohol or other drugs before or during activities with your child. 

·       Your child's Big should not use physical discipline or yell at your child. 

·       If an activity involves changing clothes (for example, swimming), there must be separate changing and showering places. If they go on an approved overnight, they must sleep in separate beds.

·       Volunteers should never ask a child to keep a secret.  

·       Volunteers might want to buy an occasional gift for your child. They should ask your advice about this first.

·       Volunteers should not engage in tickling, wrestling, giving backrubs, or asking your child to sit on their lap.

·       Seatbelts should always be worn.

·       Bigs should never drop off your child at a home where no approved adults are present or at a location other than where you specified.

·       Showing age-inappropriate videos, misusing social media, pornography or sexual material is not acceptable and is grounds for match termination. Speak to your Match Support Specialist right away if you see or suspect any of these activities are occuring. 

Contact Information