Youth Application & Policies

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

Nombre

Segundo nombre

Apellido


Fecha de nacimiento (mm/dd/yyyy)

Circule Uno




Escuela (start typing to narrow down your search. Choose "Other" if your child's school is not listed)

calificación

Identificación del Estudiante



Check all that apply






Check all that apply


Check all that apply


Check all that apply




Parent/Guardian Information

The parent/guardian is this child's
Relación con el Niño(a

Nombre de pila del Padre/Madre/Guardián

Apellido del Padre/Madre/Guardián

Teléfono móvil


I prefer to be contacted by


Está trabajando actualmente


Nombre del lugar de trabajo?

Teléfono del trabajo

Podemos contactarle al trabajo



Padre/Madre arrestado(a) actual o anterior?


Family Information




Dirección Línea 1

Ciudad


Código postal

Emergency Contact
If we are unable to reach you, who is someone we could call who always knows how to reach you?




Academic Information

Our agency utilizes student grades to assess the educational and academic needs of the students in our program. Please select how your child is performing in these subjects and answer the questions below. This information will not

 affect your child's acceptance into Big Brothers Big Sister program.








Additional Information










Fuente de referencia
Mentor/Volunteer Preferences
Big Brothers Big Sisters of the Sun Coast, Inc. does not discriminate on the basis of gender, race, creed, sexual orientation/preference or national origin. As the child's parent/legal guardian, you have the right to control who is matched by us with your child. You may require that your child only be matched to an adult mentor of a particular gender, race, creed, disability, sexual orientation/preference, or national origin, as follows:

Big Brothers Big Sisters of the Sun Coast, Inc., no descrimina en base a género, raza, creencia, orientación/ preferencia sexual o nacionalidad de origen. Sin embargo, como padre/guardia legal del niño usted tiene el derecho de controlar quien va a ser el mentor que su hijo tendrá por medio de nosotros. Usted puede requerir que su hijo solo sea matriculado con un mentor de género particular, raza, creencia, orientación/ preferencia sexual, o origen nacional, como sigue a continuación:


Check all that apply










Agency Privacy & Grievance Policies
ACCESS TO CONFIDENTIAL INFORMATION

PRIVACY: ACCESS TO PRIVATE INFORMATION

  1. In order for Big Brothers Big Sisters of the Sun Coast, Inc. (BBBSSC)BBBS to provide a responsible and professional services, it is necessary for Participants to be asked to divulge extensive personal information about themselves and their families. BBBS respects the confidentiality of Participant records and, with the exception of situations listed below, shares such information among only BBBS professional staff and anyone else who has a duty to preserve the confidentiality of such information. The rights of privacy apply to not only written records, but also video, film, picture, or use of Big’s and Littles’ names in BBBS publications.
  2. Identifying information shared with a potential Big or Little for the purposes of establishing a match is intended to remain private and is not to be shared with individuals outside of BBBS involvement. Information shared between the Big and Little during the course of the match relationship is intended to be shared solely with involved individuals such as the Big, Little, parent/guardian and BBBS staff. Limitations on privacy are outlined below.
  3. All records are considered the property of BBBS and not BBBS Participants. In order to provide Programs in the best interest of the children served, information from outside sources, including confidential references, will be reviewed along with information gained from the Participants themselves. Records are not available for review by Participants. Participants shall be provided, at the time of application, a copy of this statement.

 

LIMITS OF PRIVACY

  1. Information will be released to other individuals and organizations only upon presentation of an authorized “consent to release information” form appropriately signed by the parent or guardian or as required in a court order or other legal document.
  2. Identifying information regarding Participants may be used in BBBS publication or promotional materials if the Participant has given permission.
  3. 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 Participant records. These outside organizations shall be required to respect the BBBS privacy policy. Outside parties shall be required to use information only for the purpose(s) stated in the approved action of the Board of Directors. Known violations of BBBS privacy policy will be reported to the supervisor of the individual involved and appropriate disciplinary action shall be determined.
  4. Members of the corporate Board of Director have access to Participant files only upon authorization by formal motion of the Board of Directors. The motion shall state who can review records, the specific purpose for such review and the period of time during which access shall be granted.
    • Members shall be required to comply with the BBBS policies on privacy and may use the information only for purposes stated by the approved action of the Board of Directors. Known violations shall be reported to the Board President.
    • A violation of the BBBS’s privacy policy by a Board Member shall constitute adequate cause for removal from office.
  5. Information shall be provided to an BBBS’s legal counsel in the event of litigation or potential litigation involving the BBBS. Such information is considered privileged information, and law protects its confidentiality.
  6. State law mandates that suspected child abuse be reported to Florida Dept. of Children and Families. All workers are responsible for staying abreast of such reporting requirements of their respective jurisdiction and shall always comply with mandated procedures.
  7. BBBS worker receives information indicating a client or volunteer may be dangerous to himself or herself or others, necessary steps may be taken to protect the appropriate party. This may include a medical referral or a report to the local law enforcement authorities. 

GRIEVANCE POLICY


BBBS tries to provide consistent, quality and professional services to all Participants in accordance with the mission of the organization. However, if a Participant is dissatisfied with any action or, policy or service of BBBS, the aggrieved Participant shall take the actions:

  1. The aggrieved Participant will promptly notify the assigned Mentor Manager of the grievance and the Mentor Manager will work diligently to resolve the situation.
  2. If not satisfied, the aggrieved Participant may submit a written complaint to the Vice President of Programs ((“VPP).”), describing the details of the grievance and the relief sought.
  3. The VPP will review the matter and investigate with Mentor Manager input as well as others who might have pertinent information, including staff, Participants, family members, and others. The depth of the investigation shall be determined by the VPP. The Participant filing the grievance will receive written notification that his/her complaint is being investigated and be given an estimated time of response.
  4. The VPP will report in writing to the Participant his/her findings and take any appropriate action as deemed necessary. A copy of the findings and summary of the situation will be kept in the Participant’s file. The Chief Executive Officer (CEO) will receive a copy of the findings.
  5. If the Participant is not satisfied with the findings of the VPP, he/she may appeal to the CEO. The CEO may choose to hold a second investigation or concur with the VPPs’ findings. The Participant will be notified in writing of the response from the CEO.
  6. If the aggrieved party or BBBS disagrees with the findings and conclusions, he/she/it may pursue or other actions permitted by law, beginning with non-binding mediation.
  7. Applicants who have not been accepted as Bigs are not covered by this policy.


Updated 11/2023
Transportation Policy
The safety of children, Participants and staff paramount, whether it be a match or BBBS sponsored activity. The following applies anytime a Big or BBBS staff transport children.
  1. Parent must consent that BBBS staff member or a fully screened Big may provide transportation for their child to and from any BBBS-sponsored Program. This applies to Bigs enrolled in Community- Based, Site-Based and Site- Based Plus, and Site Base Facilitated Programs.
  2. All children will be transported utilizing a seat belt, car seat, or booster seat according to current Florida laws and regulations. Parents will be required to supply a booster or car seat as needed for their child according to Florida law. Drivers shall make sure seat belts, car seats, booster seats are used properly, and each child is properly secured before setting a vehicle in motion.
  3. All adults in the vehicle will use proper restraining devices according to the vehicle manufacturer’s recommendations and Florida law.
  4. Children must always ride in the back seat of the Big’s vehicle if they are less than 12 years old.
  5. The number of passengers in vehicle will not exceed the manufacturer’s stated capacity for the Vehicle.
  6. Children will never be left unattended in a vehicle, even for brief periods.
Driver Qualifications:
  • Drivers must provide Bigs with a valid driver’s license and proof of insurance.
  • A copy of the Big’s license and proof of insurance will be maintained on file.
  • It is the Big's responsibility to ensure that BBBS is provided with up-to-date copies of such information.
  • Drivers will be legally licensed and shall not be under the influence of any substance that may alter their ability to drive safely.
  • Drivers will meet BBBS qualifications including criminal history and DMV checks which will be obtained by BBBS staff and kept in a match file or personnel file.
  • Drivers will obey all Florida traffic regulations inclusive of prohibitions related to cell phone use and texting while driving.
  • Other factors such as age, years of driving experience, references and interviews may result in a recommendation of Site -Based mentoring only.

Home Visits and Overnight Policy
YOUTH VISITING VOLUNTEER’S HOME

Visits to the volunteer’s home by the Little are not allowed within the first three months of the match. This allows the match relationship time to become established and develop in a healthy and safe manner. Any visits occurring prior to three months will be reviewed by a supervisor to determine whether match suspension or closure is warranted.


OVERNIGHT VISITS

Unless there are unusual circumstances, during the first year overnight visits between Bigs and Littles are not allowed. After the first year, overnight visits may occur if the following measures are taken, although the BBBS does not recommend such visits.
    1. A documented assessment of healthy relationship development between a match by the Mentor Manager.
    2. A documented pre-approval and discussion with staff, parent/guardian, and Big agreeing to home visits, the expected nature and frequency of home visits, and a review of child safety practices.
    3. The Mentor Manager should periodically provide an ongoing assessment of safety levels in the match relationship and assessment of the activities and frequency of home visits.
At any time, the Mentor Manager has the authority to restrict the Big’s and Little’s activities at the Big’s home if there are concerns regarding the safety level or appropriateness of such visits. In that case, the parent/guardian and Big should be informed of the professional staff’s decision.

Exceptions must be approved by the Agency CEO or Designee. In addition, overnight visits are permitted only in cases where one of the following criteria have been met AND the required authorization steps are documented:

CRITERIA:
    1. There is genuine concern for the safety of a child returning to their own home (e.g. emergency circumstances) OR
    2. An event is formally designated by the BBBS as one that (1) is of a nature to provide an exceptionally significant developmental or educational benefit to a child or youth, and (2) that the event would not be possible without the Big accompanying the Little (e.g. a college visit for example)

REQUIRED AUTHORIZATION: The Mentor Manager shall be responsible for the following:
    1. Documented confirmation that the Big/Little relationship has been in place for at least one year.
    2. Documented professional assessment of healthy relationship development between match parties with no violations of BBBS policy, including a code of conduct.
    3. Documented pre-approval by parents/guardian, the Little, and professional staff, with the exceptions noted above.
    4. Documented plans for privacy in: sleeping, changing clothes, bathing/showering.
    5. Documented consideration of reasonable alternatives to sleeping overnight.
    6. Documented professional staff monitoring for any safety concerns following the overnight
Ultimately, it is the sole responsibility of the individual parent/guardian to make this decision regarding match overnight visits for their child. The parent/guardian must give permission to the Big for an overnight visit and must take full responsibility for monitoring it. If the parent/guardian and the Big agree upon overnight visits, it is the parent/guardian and Bigs’s responsibility to notify their Mentor Manager before each overnight visit.

Updated 11/2023
Weapons Policy
While some adults possess weapons for hunting and/or protection purposes, it is the policy of Big Brothers Big Sisters of the Sun Coast (BBBSSC) that all agency Volunteers agree to the following:
All Participants agree to the following:
  1. Inform BBBS of Weapon ownership or presence in the home. BBBS staff will discuss the ownership of weapons during the prospective Big’s interview and update that status for the life of the match. For purposes of this policy, “Weapons” may include all firearms, handguns, zip guns, anything forged as a weapon (spears, ninja stars, etc), knives (except for kitchen knives and small pocketknives not used or intended for use as a weapon or to inflict bodily injury) and explosive devices.
  2. In the case where a law enforcement official is required to carry a Weapon at all times as a condition of their employment, BBBS will document the weapon related job requirements as well as parent/guardian notification of the requirements and their approval of the condition prior to match.
  3. Ensure weapons and ammunition are inaccessible to the Little and any other child participating in a BBBS Program. The means of ensuring the inaccessibility will be discussed during the interview.
  4. A Big will not carry a concealed handgun at any time while accompanying a Little or any other child participating in a BBBS Program.
  5. A Little’s parent/guardian shall give his/her consent to the Mentor Manager before engaging in any Program in which a weapon may be used with the Little or other child participating in or present at a BBBS Program.
  6. Have the Little complete a gun safety course or equivalent and provide documentation to BBBS prior to his/her participating in any activity requiring/involving the use of a firearm. (e.g. hunting, target/clay pigeon shooting, etc.).
  7. Transport the firearm to and from any Program in compliance with state and federal laws and in a manner in which the Little cannot gain access to the firearm.
  8. Participants shall affirm that they own all their firearms and/or weapons and are properly licensed, permitted, registered, and handled in accordance with all applicable state and federal laws.
  9. Abide by any other policy or procedure BBBS may put into effect regarding Weapons.
  10. If BBBS staff, Bigs or other Participants BBBS have first -hand knowledge that any student is in possession of a Weapon (at school, school function or school sanctioned activity), that student shall be suspended from the Program and the incident be reported to the school administration immediately.
  11. A Participant who stores or leaves, on a premise under his or her control, a loaded firearm, and who knows or reasonably should know that a minor is likely to gain access to the firearm without the lawful permission of the minor’s parent or the person having charge of the minor, or without the supervision required by law, shall keep the firearm in a securely locked box or container or in a location which a reasonable person would believe to be secure or shall secure it with a trigger lock, except when the person is carrying the firearm on his or her body or within such close proximity that he or she can retrieve and use it as easily and quickly as if he or she carried it on his or her body. As used above, the term "minor" means any person under the age of 16.
NOTE: If a Big Brothers Big Sisters staff, volunteer or agent of the Agency has first hand knowledge
that any student is found to be in possession of a Gun or Weapon (at school, school function or school sanctioned activity), that student shall be suspended from the program and the incident be reported to the school administration immediately. (This is part of the Gun Free Schools Act of 1994.)
Florida Law Section 790.174
Safe storage of firearms required.

(1) A person who stores or leaves, on a premise under his or her control, a loaded firearm, as defined in s. 790.001, and who knows or reasonably should know that a minor is likely to gain access to the firearm without the lawful permission of the minor’s parent or the person having charge of the minor, or without the supervision required by law, shall keep the firearm in a securely locked box or container or in a location which a reasonable person would believe to be secure or shall secure it with a trigger lock,
except when the person is carrying the firearm on his or her body or within such close proximity thereto that he or she can retrieve and use it as easily and quickly as if he or she carried it on his or her body.

(2) It is a misdemeanor of the second degree, punishable as provided in s. 775.082 or s. 775.083, if a person violates subsection (1) by failing to store or leave a firearm in the required manner and as a result thereof a minor gains access to the firearm, without the lawful permission of the minor’s parent or the person having charge of the minor, and possesses or exhibits it, without the supervision required by law:

(a) In a public place; or

(b) In a rude, careless, angry, or threatening manner in violation of s. 790.10.

This subsection does not apply if the minor obtains the firearm as a result of an unlawful entry by any person.

As used in this act, the term "minor" means any person under the age of 16.

Media Consent and Release
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 Big Brothers Big Sisters of the Sun Coast 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. 

 


Emergency Medical Authorization












Permission Form
By signing below, 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 and/or other professionals to provide information regarding academics, medical history, psychological/psychiatric evaluations, social or behavior problems concerning my child to Big Brothers Big Sisters of the Sun Coast, Inc. (e.g. report cards, test scores, attendance and behavior history)
  4. It is understood that all information given is confidential and will only be shared with funding or auditing agencies and that there will be no contact with the volunteer outside of the school setting unless authorized by the parent/guardian and Big Brothers Big Sisters of the Sun Coast, Inc. 
  5. 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; 
  6. To have my child talk with a Big Brothers Big Sisters staff person about personal safety; 
  7. 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).hereby authorize Big Brothers Big Sisters of the Sun Coast, Inc., its director or designee to disclose information contained in said child’s records on file concerning his/her age, sex, race, religion, interests, hobbies, marriage and family status, living situation, reasons for applying to the Program, a summary of the child's needs assessment and expectations of a match to the potential match mate. I understand that the child will not be identified by name until after the match has been agreed upon.

I also agree to keep information discussed with me regarding a potential Big Brother/Big Sister match confidential. I will not discuss this information with any person other than the assigned professional staff of the Big Brothers Big Sisters BBBS.

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 Sisters of the Sun Coast 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 the Sun Coast, 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.
*For Manatee County Only: I understand this program receives funding from Manatee County Government and that Manatee County representatives may request access to any or all Agency records related to One to One Mentoring Program for the purpose of evaluating or monitoring the program delivery of services. I understand any records provided to Manatee County shall become public records and may be subject to applicable state or federal exemptions and may be copied and inspected by a third persons.


*Solo para el Condado de Manatee: Entiendo que este programa recibe fondos del Gobierno del Condado de Manatee y que los representantes del Condado de Manatee pueden solicitar acceso a cualquiera o todos los registros de la Agencia relacionados con el Programa de Mentoría One to One con el fin de evaluar o monitorear la prestación de servicios del programa. Entiendo que cualquier registro proporcionado al Condado de Manatee se convertirá en registros públicos y puede estar sujeto a exenciones estatales o federales que sean aplicables y puede ser inspeccionado por un tercer partido.




Updated 11/2023

Contact Information