Parent/Guardian/Little Application

Parent/Guardian Information

Optional - We will only call this number if necessary.
Legal Guardianship Information

Youth Information

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Parent Preferences for Match
Big Brothers Big Sisters of the Tri-State does not discriminate on the basis of race, age, sex, gender identity or expression, disability, marital status, sexual orientation, religion, or national origin. We will always honor your preferences, but please note that the more restrictions you place on a Big, the longer it may take to match your child.  
Please tell us if you have preferences for a Big who identifies with the following items (write "No preference" or something similar if you have no preferences):

Emergency Contact Information
If there is an emergency and we can't get in contact with you, who would you prefer us to call instead?

Family/Household Information
Parents/Guardians: Please note that this information is confidential and is used only to help us secure funding that will help us continue to serve the children in our communities. 

Parent/Guardian Permission

I agree to the following:

1. I give permission for my child to participate in the Big Brothers Big Sisters Community, School Based, School Based Plus or Workplace Plus program.
2. I give permission for an agency representative to obtain additional information that may be helpful to the agency’s matching process, this may include information from the school/school board, other social service agencies or counseling references.
3. I understand that information about my child will be shared with a potential Big Brother/Sister and that my child and I will not be identified to a potential Big Brother/Sister until all parties have agreed to the match proposal.
4. I understand that information shared with me about a potential Big Brother or Big Sister will be confidential and I will not discuss such information with anyone other than the Big Brothers Big Sister staff.
5. I agree that a member of the Big Brothers Big Sisters staff will discuss safety with my child and will conduct an age appropriate safety training with them.
6. I acknowledge that the Big Brothers Big Sisters staff is required to report any known or suspected abuse or neglect of my child or occurring within my home.
7. I understand that even if my child is selected to be a part of the Big Brothers Big Sister program that he/she may have to wait for a volunteer mentor and it is additionally not guaranteed that my child will ever receive a Big Brother or Big Sister.
8. I understand that my child’s mentor will have gone through the Big Brothers Big Sisters screening necessary for the program they are applying for which includes at a minimum an in-depth interview, reference checks, and background checks.
9. I understand that when my child is matched to a Big Brother or Big Sister that we all (Big, parent, and child) will be required to do mandatory match support/supervision in order to maintain a healthy, safe and effective match relationship. I understand that a failure to adhere to this supervision schedule can result in the closure of my child’s match. 
Click the button below to review your application, and then sign at the bottom.