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.
In determining an applicant’s
suitability for our program, factors such as the health, personality, behavior,
employment and educational status of the individual are taken into
consideration. An interview with a staff
member is part of the application process and is designed to establish a
profile of you and your interests.
Additional information about you will be obtained from the character
references you supplied, from background checks performed through the Child
Abuse Registry, the State of Virginia
Criminal Records Check and the Division of Motor
Vehicles. Big Brothers Big Sisters
Services, Inc. may also make use of other information concerning an applicant
acquired by the agency from other persons, agencies, or other sources that may
come to its attention.
Excepting any disclosures to
which the agency is subject as a matter of law, all information received
concerning an applicant will be treated as confidential and will not be
disclosed to anyone except in connection with the administration and operation
of the agency and its Big Brother Big Sister program.
The undersigned acknowledges
and agrees that: he/she is not obligated
if called upon, to perform the services herein applied for, and that the agency
is not obligated to accept him/her as a volunteer or to assign, or actively
seek to assign him/her a Little Brother/Little Sister.
All information obtained
about any volunteer and any information pertaining to a match between a
volunteer and a child are the property of and will remain the property of our
agency. An applicant has no right to
obtain, review or copy any such information or files. Applicants who are not accepted will not
necessarily be told of the specific reasons for their non-acceptance; as to do
so could jeopardize the screening policies of the agency. The applicant will be informed by letter of
his/her non-acceptance by the Executive Director.
In the event a match is made,
the undersigned also acknowledges and agrees that: the parent(s) or guardian of the child, the volunteer
himself/herself, or the school has the right to terminate the relationship. If
the agency determines the best interests of the child would be served by the
termination of the match, then the agency reserves the right to, and in sole
discretion may, terminate the services of the volunteer. Further, in the event
of such termination by the professional staff, Big Brothers Big Sisters
Services, Inc. is not obligated to provide the volunteer with the specific
reason(s) for such termination.
NOTICE: By signing this application you are hereby advised that any and
all suspicions of child abuse and/or sexual misconduct involving children,
whether physical or verbal, will immediately be reported to the appropriate
authorities and any individual found guilty of these offenses will be
prosecuted to the fullest extent of the law.
The undersigned certifies that all information included in this application is true and correct to the best of their knowledge.
I authorize Big Brothers Big Sisters Services, Inc. to contact my employer and the individuals I have named as personal references.
I authorize Big Brothers Big Sisters Services, Inc. to contact any other BBBS agencies or named Youth Serving Organizations I have applied to or worked with in the last 5 years to obtain reference information.
I agree to advise Big Brothers Big Sisters Services, Inc. immediately of any changes in the information provided or representations made in this application.
I COMMIT TO MENTORING A CHILD FOR A MINIMUM OF 1 YEAR (12 MONTHS)
ON A CONSISTENT BASIS FROM THE TIME THE MATCH IS MADE.
I hereby accept the
invitation of Big Brothers Big Sisters of America (BBBSA) and Big Brothers Big
Sisters Services, Inc. to appear and be identified in print in any BBBSA or
BBBS Services, Inc. publication or production, or grant the right to use the image
of a volunteer as specified below.
I hereby grant to
BBBSA and its affiliates the right to use this image, name, and biographical
information as they may desire, in all media and in all forms including, but
not limited to, publications, any televised photography and recordings.
In consideration of
$0 to me paid, I hereby grant to BBBSA and BBBSA affiliates the absolute right
to use this image made through BBBSA studios or elsewhere, in whole or in part,
in true or distorted character or form, alone or in conjunction with any other
image, name or reproduction, in color or otherwise, for art, advertising,
business, trade, or any other lawful purpose whatsoever, in perpetuum.
Big Brothers Big Sisters Services, Inc. respects the
confidentiality of client and volunteer records and, with the exception of situations
listed below, shares information about clients and volunteers only among the
agency professional 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 the
clients or volunteers.
Information will be released to other individuals or non-BBBS
organizations only with the client or volunteer’s written consent or with
the understanding that the respective parties have agreed to adhere to
this confidentiality policy.
For purposes of program evaluation, audit, or accreditation, and
with the prior approval of the Board of Directors, certain outside bodies
such as Big Brothers Big Sisters of America may have access to client and
Members of the Board of Directors or evaluators appointed by the
board have access to client files upon authorization of the Board of
Information shall only be provided to law enforcement officials of
the courts pursuant to a valid and enforceable subpoena.
Information shall be provided to an agency’s legal counsel in the
event of litigation or potential litigation involving the agency.
State law mandates that suspected child abuse be reported to the
appropriate authorities (Virginia Department of Child Protective Services Hotline 1-800-552-7096).
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.
At the time a child or volunteer is considered as a match
candidate, information is shared between the prospective match
parties. The information about the
volunteer may include such items as: age, sex, religion, interests,
hobbies, marriage, family status, sexual orientation, living situation,
etc. Information about the child
may include such items as: age, sex, race, religion, interests, hobbies,
family situation, etc.
The client or volunteer agrees not to
disclose personal information about the respective parties to anyone outside of
My consent below indicates that I have answered all questions on this
page truthfully. I am aware that according to Big Brothers Big Sisters
Services, Inc. my status as a volunteer makes me a mandated reporter of any
suspicion of child abuse and/or neglect.
My consent at the bottom of this page also indicates that I promise to
abide by the Code of Conduct for volunteers of Big Brothers
Big Sisters Services, Inc.:
To avoid the use of tobacco products when in the company
of my Little.