Youth Inquiry Form

Youth Inquiry Form

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.

Youth Information

You may add additional youth by clicking on the "Add another child" button below.

First Name

Last Name

Preferred Name

Birthdate

Enter a date in the following format: mm/dd/yyyy

Gender

Personal Pronouns

How does the youth identify?

What pronouns does the youth use?

Youth Race/Ethnicity

American Indian or Alaska Native	Asian - Chinese
Asian - Filipino	Asian - Indian
Asian - Japanese	Asian - Korean
Asian - Other	Asian - Vietnamese
Black or African American	Hispanic - Cuban
Hispanic - Mexican,Mexican American,Chicano	Hispanic - Other Latinx or Spanish origin
Hispanic - Puerto Rican	Middle Eastern or North African
Pacific Islander - Chamorro	Pacific Islander - Native Hawaiian
Pacific Islander - Other	Pacific Islander - Samoan
White or Caucasian	Other
Prefer not to say

Please check all that apply.

School

Grade

12-Grade

What are the youth's top 3 interests or hobbies?

Anime, Manga, etc	Art (painting, drawing, pottery, photography, etc)
Board Games & TTRPGs	Content Creation
Cooking & Baking	Cosplay
Dance	DIY (fixing homes, cars, etc)
Electronics & Robotics	Fiber Arts (sewing, knitting, crochet)
Gardening & Plants	Hiking & Climbing
Music	Outdoor Hobbies (Fishing, Archery, Hunting, etc)
Playing Sports & Athletics	Reading
Snow Sports (ski, snowboard, etc)	Video Games
Watching Sports	Writing
Other

What is the hobby?

Parent/Guardian's Relationship to Youth

Application Name

Parent/Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name

Mobile Phone

Personal Email

I prefer to be contacted by

Family Information

Mailing Street Address

Mailing City

Mailing State

Mailing Zip Code

County:

Hidden Fields

Agency Location ID

How did you hear about us?

Always Known	BBBS Staff/Board Member
Community/Service Organization	Counselor/Therapist
Current/Former BIG	Google/Web Search
Neighbor/Friend/Relative	Print Media (Brochure, Flyer etc)
School	Social Media (Facebook, Instagram, etc.)
Special Event	TV or Radio

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Contact Information