______I authorize Big Brothers Big Sisters of Metropolitan Chicago ("BBBSChi "), its staff and its agents, to investigate my background, health, character and personal history in any manner it sees fit, and, I authorize all persons, companies, schools, law enforcement, and other agencies to release to BBBSChi all information concerning such subjects and otherwise concerning my suitability to become a volunteer. I understand that this may include, but is not limited to, an arrest record check through the Illinois State Police and a driving record check through the Illinois Secretary of State's Office. I also understand this information will be used to determine my eligibility to be a Big Brother/Big Sister. I understand that if I am accepted to be a volunteer, BBBSChi will conduct ongoing criminal background and driving record checks periodically while I remain a volunteer.
______I, for myself, my heirs, executors and administrators, hereby release and forever discharge BBBSChi , its officers, directors, employees and agents, and all other personnel, companies, schools, organizations, law enforcement and other agencies and their officers, directors, employees and agents from any and all causes of action, suits, damages, liabilities, costs, debts, sums of money, claims and demands of any sort whatsoever, and any and all related attorney's fees, court costs and other expenses, in each case that result from or relate to my relationship with any youth I volunteer to mentor or that otherwise result from or relate to my services as a volunteer or my application to become a volunteer. I acknowledge that my services as a volunteer may include activities in areas that may have a higher than average incidence of crime, and the foregoing release and discharge covers, without limitation, any damages or injury I may sustain while engaged in activities related to BBBSChi .
______I give permission for any staff member of BBBSChi to review all information contained in my volunteer file for the purpose of matching, evaluation, program audit and staff training. I also give permission to BBBSChi 's Program Committee and to the staff and agents of Big Brothers Big Sisters of America to review my volunteer file in connection with their periodic audit for purposes of evaluation.
______I understand that all information obtained from me or about me will be held in confidence by BBBSChi . I will only have access to my application. All other information concerning me, including but not limited to information derived from my references, the investigative process, interviews or otherwise, will be the sole property of BBBSChi . BBBSChi will not release to outside sources, unless required by law, information from my volunteer file other than verification that I am a volunteer, without my prior written consent.
_____I irrevocably consent to any and all uses and
displays of my name, image, likeness, appearance, and basic biographical
information in, on, or in connection with any advertising, publicity,
marketing, or printed or electronic media, of any type, throughout the world at
any time by Big Brothers Big Sisters of America, [BBBSA affiliate], and
any of their affiliates, successors, partners, sponsors, donors, and any
entities or persons with whom they conduct any public relations, marketing, or
fund raising of any type, without further consent from me or without any
royalty, payment, or other compensation to me, 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.
**If you do not want to consent to media/social media release, please inform a BBBSChi staff member.
______I understand that as a BBBSChi volunteer I am required to notify BBBSChi promptly of any changes in the information I have provided during the application process that may alter my ability to serve in the capacity for which I have applied, including any changes in medical, psychological, or arrest history. I understand that such information may be released to the parent or guardian of a child with whom I am matched, and I consent to the release of such information.
______I understand that BBBSChi reserves the right to reject a candidate for any reason that BBBSChi , in its sole judgment, determines will or may affect either the best interests of a Little Brother/Little Sister or BBBSChi . Furthermore, BBBSChi reserves the right to withhold the reasons for such refusal.