Volunteer Enrollment Form - Community-based

Save my progress and resume later | Resume a previously saved form

Resume Later

In order to be able to resume this form later, please enter your email and choose a password.

Your Email:

A Password:

Confirm Password:

Password must contain the following:

12 Characters
1 Uppercase letter
1 Lowercase letter
1 Number
1 Special character

Non-Discrimination Policy

Our funders require that we collect the information in this form. It will not affect your enrollment as a Big/Volunteer.

Big Brothers Big Sisters of Metro Milwaukee does not discriminate on the basis of gender, race, color, physical condition, marital status, religion, sexual orientation, national origin or disability.

Basic Information

Contact ID 18 Character

Enrollment ID 18 Character

Contact Owner ID

Contact Owner Email

Legal First Name

Middle Name

input NA if none

Last Name

Maiden/Alias

input NA if none

Date(s) of name change

input NA if none

Preferred Name

Application Name

Birth Date

Must be listed as MM/DD/YYYY

Gender

Personal Pronouns

Sexual Orientation

How do you identify?

What pronouns do you use?

Sexual Orientation Write-in

Race/Ethnicity (Select all that apply)

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
Other	Pacific Islander - Chamorro
Pacific Islander - Native Hawaiian	Pacific Islander - Other
Pacific Islander - Samoan	Prefer not to say
White or Caucasian

Tribal & Regional Corporation Affiliations

Nationality

To select multiple, hold CTRL and click.

Relationship Status

Spouse/Significant Other Full Legal Name and Birthdate

Legal First Name

Middle Name

Input NA if none

Last Name

Maiden/Alias

Input NA if none

Date(s) of name change

Input NA if none

Birth Date

Driver's License Number

Driver's License State

Driver's License Expiration

Please upload a copy of your driver' s license or government ID.

File can be a screenshot, PDF, or picture.

Social Security Number

Auto Insurance Effective Date

Auto Insurance Company

Please upload a copy of your auto insurance.

File can be a screenshot, PDF, or picture

Residence History

List all cities and states in which you have lived and your approximate dates of residence.

City/State

From

Contact Information

Personal Email

Work Email

Alternate Email

Preferred Email

Mobile Phone

Work Phone

Work Phone Extension

Home Phone

Alternate Phone

Preferred Phone

Best Time to Call

In general, do you prefer to be contacted by email or phone?

Mailing Address

Mailing Street Address

Mailing City

Mailing State

Mailing Zip Code

County

Mailing address is different from residential address

Physical Address

Street Address

City

State

Zip Code

County (Milwaukee/Waukesha)

Emergency Contact Information

Name

Phone

Relationship

Are there other adults who live with you?

YesNo

To ensure safety, our process includes a basic screening of other adults living in a volunteer's home. Please list the full name, other names used (maiden, alias, etc.), and birth date of ALL adults 18 years or older living in your home.

Full Legal Name

Birth Date

Total Number in household including spouse/significant other, above adults, and children

Employer Information

Occupation

Name of Employer or School

Employment Length (Years)

Employment Length (Months)

Employer or School Address Line 1

Address Line 2

City

State

Postal Code

Additional Information

Level of Education

Have you served in the military?

How would you describe yourself, in terms of participation in events, activities, or sports?

Which activities do you enjoy more?

Do you speak any languages other than English?

Spanish	African Languages (Swahili, Bantu)
American Sign Language	Arabic
Asian: Other	Chinese
Creole	Dutch
Eastern European (Czech, Slovak)	French
German	Greek
Hebrew	Hmong
Indian (Hindi, Punjabi)	Italian
Japanese	Keres (West)
Korean	No Preference
Nordic	Persian
Portuguese	Russian
Turkish	Lao

How did you hear about Big Brothers Big Sisters?

What interests you about becoming a volunteer with Big Brothers Big Sisters?*

Referral Detail ID

Are you experiencing any physical or mental health problems?

Yes

Please explain:

Have you ever been arrested, charged, or convicted of a crime?

Yes

Please provide details:

Have you had any driving citations and/or moving violations in the past five years?

Yes

Please provide details:

Do you anticipate any significant life changes that would interfere with our minimum two-year commitment?

Yes

Please provide details:

Have you experienced any significant life changes in the past year?

Yes

Please provide details:

Do you have any pets?

Yes

Please indicate the type(s) of pet(s) and describe any history of aggression (biting, etc.)

Do you own any guns?

No	Yes, guns are secured

Please describe your personality, interests, hobbies, and anything else you'd like to tell us about yourself.

Social Media: Please list your account name(s) for all relevant social media sites (i.e. Facebook, Instagram, Twitter, LinkedIn, Tik Tok)

Previous Experience

Have you previously applied to be or served as a Big Brother or Big Sister here or anywhere else?

When?

Where?

References

Please provide at least three references. If you listed a Spouse/Spousal Equivalent or Significant Other above, their information is required as the first reference below. Substitute a family member (biological or chosen) ONLY if no Spouse/Spousal Equivalent or Significant Other.

Spousal/Familial Reference

Spousal/Familial Reference ID

First Name

Last Name

Phone

Email

Relationship to you

Years Known

Professional Reference (non-family member)

Professional Reference ID

First Name

Last Name

Phone

Email

Relationship to you

Years Known

Personal Reference

Personal Reference ID

First Name

Last Name

Phone

Email

Relationship to you

Years Known

Have you held a volunteer or paid position where you worked with children in the past five years that is not listed above as a reference (for example counselor at a camp, babysitting, nannying, coaching, etc.)?

Volunteer Experience

YSO Reference ID

Organization Name

Direct Supervisor First Name

Direct Supervisor Last Name

Phone

Email

Years Known

Reason for Leaving

Volunteer Rules and Responsibilities

Big Brothers Big Sisters of Metro Milwaukee focuses on ensuring child safety, supporting Bigs and Littles in forming long lasting, positive relationships and helping youth reach positive outcomes. Please review each of the following policies and sign at the bottom of the page to indicate you are aware of your responsibility, as a Volunteer, to uphold the policies of Big Brothers Big Sisters of Metro Milwaukee.

Safety

OVERNIGHT POLICY - I understand Big Brothers Big Sisters (BBBS) does not allow overnight match activities. Violation of this rule will result in the closure of my match.

MANDATED REPORTING - BBBS staff are mandated reporters and are required by law to report any signs of child abuse or neglect. I must contact my Match Support Specialist (MSS) or the BBBS Emergency Line immediately if I have concerns about the safety of my Little or someone in my Little’s family.

SUPERVISION - I understand I must supervise my Little at all times. I will never leave my Little unattended or with any other person during our outings. I understand BBBS requires an adult (someone 18 or older) to be present when I pick up and drop off my Little.

APPROPRIATE BEHAVIOR - I understand BBBS has a zero tolerance policy for illegal drug use. I understand smoking or consuming alcohol is STRICTLY PROHIBITED before and/or during outings with my Little. I will always use appropriate language and model appropriate behavior when spending time with my Little.

SAFE ACTIVITIES - I will always choose safe and age-appropriate match activities. My Little and I will wear appropriate safety gear for activities such as biking, swimming or boating.

TRANSPORTING YOUTH
I understand BBBS follows Wisconsin laws and recommendations that children ages 4-7 must sit in the backseat in a booster seat, and all children must sit in the backseat until age 13. Seatbelts are required at all times for both my Little and me. (Contact your MSS if you have questions or need to borrow a booster seat from BBBS.)

I am the only person authorized to transport my Little unless approved in advance by my MSS and my Little’s caregiver.

BBBS policy prohibits the use of a cell phone when driving a Little. I will pull over and safely stop the vehicle before using my cell phone.

I will maintain liability auto insurance coverage as required by the State of Wisconsin. I will immediately notify my MSS if my driving privileges or auto insurance coverage changes.
BACKGROUND CHECK - I understand annual background checks, including electronic media, driving records check and criminal background screening will be conducted by BBBS. I will contact my MSS immediately if I have ANY CONTACT with law enforcement including, but not limited to, receiving a citation or being arrested for a DUI, disorderly conduct, domestic violence or battery.

FIREARMS AND WEAPONS - I agree to never carry or possess a weapon at any time on my person or in my vehicle while in the company of a youth in BBBS. Hunting or shooting a firearm is not an approved BBBS match activity. If I own a weapon(s), I will keep all weapons locked and inaccessible to a youth in BBBS. I will notify BBBS immediately if I obtain a weapon during the time I am involved in the BBBS program.

BBBS MEMBERSHIP/EMERGENCY CARD - I understand this card provides emergency contact, doctor and allergy information for my Little. I will ensure the information is up-to-date and carry this card with me during each outing with my Little.

Match Support

MATCH SUPPORT CONTACT - I understand BBBS requires me to be in contact with my MSS at least every 30 days during the first year of my match and at a minimum every 90 days thereafter. Keeping in touch with my MSS is not only a requirement, but also a resource BBBS provides to help support my match. I understand lack of communication with my MSS will result in my match being closed.

CONCERNS - If I have concerns or a problem arises in my match relationship I will contact my MSS immediately.

GOAL SETTING - I will work with my Little, my Little’s caregiver and my MSS to set goals for my Little related to achieving educational success, avoidance of risky behaviors, higher aspirations, greater confidence and better relationships.

UPDATES/CHANGES - I will contact my MSS promptly regarding any change in address or phone number for my Little or me. I will also contact my MSS if changes arise in my life such as marriage, divorce, name change, children, serious illness or living situation (ex: new roommate).

CLOSURE - I agree to communicate with my MSS if changes in my life or concerns about my match relationship arise. My MSS will provide support, problem solving and coaching. Ultimately, if my match relationship must end through BBBS, I will actively participate in the closure process recommended by my MSS. (Reference the Volunteer Training Handbook provided at Volunteer Pre-Match Training for Steps to Match Closure.)

Friendship

COMMITMENT AND CONSISTENCY - I understand it is my responsibility to have 2-4 outings/activities per month and maintain weekly communication. AR-SA">Outings/activities can be virtual, in-person (following BBBS guidelines), or a combination of virtual and in-person. I understand BBBS encourages long-lasting relationships and matches can remain open until my Little turns 18, graduates high school, or through the first year of their post-secondary. Matches can continue through our Post-Secondary Program (PSP) for 1 year following Little’s high school graduation.

FREQUENCY OF OUTINGS - I will spend time with my Little 2-4 times per month for approximately 2 to 4 hours for in-person outings. Virtual meetings should be 20-60 minutes. I will obtain approval from my MSS and my Little’s caregiver if I plan to have more than 2 outings with my Little in one week’s time or we plan to have an outing that exceeds 6 hours.

ONE-TO-ONE - I understand the focus of the BBBS program is one-on-one time with my Little. I will obtain permission from my Little and my Little’s caregiver on the rare occasion of including others on our outings. I understand that I assume responsibility and liability for any other person who is not enrolled in BBBS and participates in our outing.

COMMUNICATION WITH LITTLE - I will be in regular communication with my Little, especially if a week goes by that I am unable to meet with my Little in-person. I will discuss with my Little’s caregiver if my Little and I choose to communicate by phone, email, or text messaging.

RESPECT - I understand my Little and I may come from different backgrounds. I will be open-minded and non-judgmental regarding my Little and my Little’s family. I will contact my MSS with any questions or concerns. I will show respect at all times for my Little and his or her family.

FAMILY CONFIDENTIALITY – I understand I will learn personal information about my Little. I will not share identifying or personal information about my Little or my Little’s family with others.

MATCH CONFIDENTIALITY - I understand trust between my Little and me is very important. I will maintain my Little’s confidentiality unless it pertains to my Little’s safety. I will contact my MSS with any questions or concerns.

Boundaries

PERSONAL SPACE - I understand physical contact including, but not limited to, backrubs, sitting on laps, wrestling, rough housing or tickling is not allowed. Affection is best expressed through positive affirming comments. Physical affection may be expressed using a handshake, high-five, pat on the back or hug. I will only express physical affection after obtaining my Little’s permission.

INAPPROPRIATE MATERIAL - I will never display inappropriate materials or initiate discussions of a sexual nature with my Little.

PHOTOS - My Little’s caregiver has the right to view any photos I take of my Little. I will never photograph my Little in his/her bathing suit, undergarments, or without clothing.

PRIVATE RESTROOMS/CHANGING AREAS - I will always provide separate/private areas for my Little to use the restroom and/or change clothes. I understand bathing my Little, showering or nude swimming with my Little is not permitted.

DISCIPLINE - I will never use physical contact or abusive language to correct my Little’s behavior. If my Little misbehaves during an outing, I can state expectations for behavior and verbally address behavior concerns. If my Little does not respond, I will take my Little home and inform my Little’s caregiver and my MSS of the situation.

ACTIVITIES AT VOLUNTEER’S HOME

3 MONTH WAITING PERIOD - My Little and I are not allowed to visit my home during the first 3 months of our match. Once we have been matched for at least 3 months and if I wish to have an activity at my home, I must obtain approval from my MSS and my Little’s caregiver. I will contact my MSS if I need activity ideas in the community.

APPROPRIATE ROOMS - I understand that my Little should never enter my bedroom or any other bedrooms in my home. Appropriate areas for activities are kitchen, living room or other common areas.

LOW/NO-COST ACTIVITIES - I understand I am encouraged to do activities at a nominal cost, but I should expect to spend some money while in the program. My Little’s family might not be able to contribute money, so I will keep this in mind when planning our activities. BBBS provides staff planned and facilitated REACH activities for my match.

GIFT GIVING - I understand gift giving should be limited to special occasions such as a birthday, holiday, special event or recognition of my Little’s achievement. I will receive prior approval from my Little’s caregiver and will limit the amount of a gift or special activity to $50 or less. Gifts should never be purchased and kept at my home without the permission of my Little’s caregiver and my MSS.

FINANCIAL ASSISTANCE/DONATIONS - I am not expected to provide funds, run errands or serve as a resource for my Little’s family. BBBS discourages me from donating money, tuition, rent, furniture, clothing, or any professional services to my Little’s family. I understand any donation must be discussed with and approved in advance by my MSS.

COMMUNICATION/RELATIONSHIP WITH CAREGIVER - I understand it is important to have a healthy relationship with my Little’s caregiver. I will discuss and obtain permission from my Little’s caregiver for each match activity. I will keep conversations focused around our match, my Little’s well-being, educational success, and progress toward goals. If my Little’s caregiver needs additional support or services that are outside my role as a mentor, I will encourage him/her to contact BBBS directly for resources.

Volunteer Acknowledgement

Big Brothers Big Sisters of Metro Milwaukee maintains liability insurance coverage to protect volunteers while with a child from the program. It is important that you as a volunteer fully understand agency rules and policies. A violation of a rule or policy may limit your right to coverage by the agency’s policy and/or closure of your match.

By filling my name below, I indicate that I have reviewed the above agency rules and policies, and I understand and agree to my responsibilities as discussed.

Volunteer Full Name

Confidentiality Policy

Big Brothers Big Sisters of Metro Milwaukee respects the confidentiality of all program participants’ (defined as Parent/Guardian/Caregiver, Child and Volunteer) records and, with the exception of situations listed below, shares information about program participants only among agency professional staff. In order to provide service, in the best interest of the children served by the program, information from outside sources, including confidential references must be assessed along with information gained from the program participants. It is the agency’s responsibility to protect the confidentiality of reference responses and counseling reports by not disclosing their content to a participant applicant. Therefore, the agency will not disclose the reason for non-acceptance to the potential program participant.

All records are considered the property of the agency and not the agency workers or program participants themselves. Records are not available for review by the program participants. All program participants must sign this summary statement indicating an understanding of the agency’s confidentiality policy and agree to program participation under the guidelines before being accepted into the program.

Information will be released to other individuals or non-BBBS organizations only with the program participants’ written consent. Identifying information regarding program participants may be used in agency publications or promotional materials unless the client requests otherwise. 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 program participant records. Members of the Board of Directors or evaluators appointed by the Board have access to program participant files upon authorization of the Board of Directors. Information shall only be provided to law enforcement officials or 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 suspected child abuse be reported to the appropriate authorities (Bureau of Milwaukee Child Welfare, Waukesha County Dept. of Health & Human Services and/or local law enforcement agency). If an agency staff receives information indicating that a program participant may be dangerous to him/herself or to others, necessary steps will be taken to protect the appropriate party. This may include a 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 by the agency with the prospective match parties. The information about the volunteer may include such items as: age, sex, race, religion, interests, hobbies, marriage, family status, sexual orientation, living situation, etc. Information about the child/parent may include such items as: age, sex, race, religion, interests, hobbies, family situation, sexual orientation, living situation etc.

I understand that some information, including opinions of the agency staff, may be shared with parents of a potential Little Brother or a Little Sister or a potential volunteer. I hereby give my authorization for such limited release and use of information that may otherwise be deemed confidential pursuant to the policies contained in the complete confidentiality policy statement and I release and waive any liability against the organization, all Big Brothers Big Sisters staff and the Board of Directors of said organization.

Volunteer Acknowledgement

I have read and understand the above information provided to me regarding Big Brothers Big Sisters' Confidentiality Policy. I agree by the conditions set forth.

Volunteer Full Name

Communicable Disease Policy

Big Brothers Big Sisters of Metro Milwaukee’s (BBBS) decisions involving persons who have communicable diseases shall be based on current and well-informed medical judgments concerning the disease, the risks of transmitting the illness to others, the symptoms and special circumstances of each individual who has a communicable disease, and a careful weighing of the identified risks and the available alternative for responding to a Volunteer or Child with a communicable disease.

Communicable diseases include, but are not limited to, measles, influenza, viral hepatitis-A (infectious hepatitis), viral hepatitis-B (serum hepatitis), human immunodeficiency virus (HIV infection), AIDS, AIDS-Related Complex (ARC), leprosy, Coronavirus (COVID-19), Severe Acute Respiratory Syndrome (SARS) and tuberculosis. BBBS may choose to broaden this definition within its best interest and in accordance with information received through the Centers for Disease Control and Prevention (CDC).

BBBS will not discriminate against any Volunteer or Child based on the individual having a communicable disease. BBBS reserves the right to exclude a person with a communicable disease from the programs and functions if the organization finds that, based on a medical determination, such restriction is necessary for the welfare of the person who has the communicable disease and/or the welfare of others.

BBBS will comply with all applicable statutes and regulations that protect the privacy of persons who have a communicable disease. Every effort will be made to ensure procedurally sufficient safeguards to maintain the personal confidence about persons who have communicable diseases.

Volunteer Acknowledgement

I have read and understand the above policy, which states the Big Brothers Big Sisters agency policy with respect to communicable diseases of the program participants. I agree to participate in the program and comply with the conditions set forth above.

Volunteer Full Name

Weapons/Firearms Policy

I attest to ownership of weapons, firearms or ammunition which are licensed, permitted, registered, and handled in accordance with all applicable state and federal laws. I agree to never carry or possess a weapon at any time on my person or in my vehicle while in the company of a youth in BBBS. Hunting or shooting a firearm is not an approved BBBS match activity. I will keep all weapons locked and inaccessible to a youth in BBBS. I do not have any weapons, firearms or ammunition in my home.

Volunteer Acknowledgement

I agree to never carry or possess a weapon at any time on my person while in the company of a youth in BBBS.

Volunteer Full Name

Background Check Policy

Big Brothers Big Sisters of Metro Milwaukee conducts criminal history record checks on all prospective Volunteer Bigs at enrollment and on all active volunteers annually. Criminal history record checks include a search of public domain records, driving records, criminal background check, fingerprint check, and other records where required by local, state or federal law for volunteers working with youth. Information gained from background checks may be discussed with the potential or active Volunteer Big and then discussed with the Little’s Parent/Guardian to ensure child safety.

Volunteer Acknowledgement

Volunteer Full Name

Social Media Guidelines for Volunteers

We realize that many of our volunteers are active on social media channels such as Facebook, TikTok, Instagram, and Snapchat. As a volunteer mentor for Big Brothers Big Sisters, and ultimately a representative of our organization, we want you to follow these guidelines when engaging on social media.

Safety of Littles/Mentees is our number one priority.
It is very important to keep child safety, youth protection, and confidentiality in mind when communicating on social media. Please refrain from providing identifying information about your Little/Mentee (i.e. last name, home address).

Acceptable: 'Having a great time supporting my Little/Mentee at their high school basketball game tonight!'
Not acceptable: 'Having a great time supporting my Little/Mentee Jack Smith at his Riverside High School basketball game tonight alongside his mother Jane Smith!'
*By specifying name, location, personal information, and in real time you could jeopardize your Little's/Mentee's safety.
*Be sure privacy controls and settings are in place to restrict accessibility of the Little/Mentee to only age-appropriate content when using volunteer’s device. Volunteers must report any social media misuse or viewed content that may endanger the Little/Mentee’s health, safety, or well-being.
A parental release form is required for photos.
In order to share pictures or information about Littles/Mentees in our program, Big Brothers Big Sisters of Metro Milwaukee needs to obtain an approved Media Release signed by the parent/guardian. Before posting any information or photos of your Little/Mentee, it is your responsibility to check with your Match Support Specialist, School-based Coordinator, or mentor2.0 Coordinator to find out if your Little’s/Mentee’s parent/guardian has signed and approved our BBBS Media Release.
You are responsible for your actions and communications. Please exercise sound judgment when using social media channels.
Anything you post that could potentially tarnish our organization’s image or have a negative impact on our organization is your responsibility. When in doubt about whether or not something is appropriate to post, consult with your Match Support Specialist, School-based Coordinator, or mentor2.0 Coordinator prior to posting.
Online privacy does not exist.
Do not assume that things you publish on a private personal profile cannot be accessed. No matter what settings are applied to your social networking sites, all it takes is for someone to copy or record that information on to a public site or share it with others.
Do not post anything that exemplifies questionable behavior as a role model for a child.
No inappropriate language, behavior, sexual references, seemingly drunken behavior, night club activities, etc. should be referenced or shown in pictures, whether you are partaking or not. As a Big/Mentor, you are a representative of Big Brothers Big Sisters and should reflect this through all of your social media messages and content, even if Big Brothers Big Sisters isn’t directly connected to the message. Also, be careful of questionable messaging on T-shirts, etc. in pictures. You are serving as a role model for your Little/Mentee and for the community. You must ensure all content is appropriate and child-friendly, in case your Little/Mentee or their family sees your social media posts.
We strongly urge you to keep your profile set to private and closely monitor friend requests and followers on social media.
The people you associate with on social media are a direct reflection of you. Please be aware that, as a volunteer mentor, your interactions with others reflect on our organization too.
If your Little/Mentee is age appropriate, obtain parent/guardian permission before connecting with your Little/Mentee on social media. If permission is granted, you must follow these guidelines:

Ensure your Little/Mentee meets the age requirement of the particular social media.
Evaluate what information would be appropriate for your Little/Mentee to see. Consider adjusting your preferences and/or settings to ensure your Little/Mentee only has access to appropriate posts and photos.
Refer to guidelines 1 and 2 to ensure safety, confidentiality, and parent/guardian consent before posting information or photos about your Little/Mentee.
Littles/Mentees should never be identified and 'tagged' in photos.
Please be aware that BBBS strongly encourages parents/guardians have access and monitor their child's account.
*BBBS approved communication methods (MentorHub, email, text, phone, mail, video conferencing) between volunteer Bigs/Mentors and Littles/Mentees within varying program types.

Big Brothers Big Sisters has the right to monitor social media activity of our Bigs/Mentors. BBBS conducts annual background checks on all volunteer mentors. This includes electronic media checks. If you are using social media inappropriately, BBBS staff will coach, require changes, limit and/or prohibit communication on social media with your Little/Mentee. If you continue inappropriate social media use, your relationship with our organization could be terminated.

Volunteer Acknowledgement

I have read and understand the social media guidelines set by Big Brothers Big Sisters of Metro Milwaukee, and pledge to abide by these guidelines when using social media.

Volunteer Full Name

Virtual Communication Platform Consent

Big Brothers Big Sisters has developed a digital platform to help Bigs and Littles stay in touch more easily in a safe and secure way. Participation in this platform and use of other electronic communication tools requires permission.

I consent, should I be matched, to having contact with my Little through Big Brothers Big Sisters' digital platform.

Volunteer Full Name

Media Consent and Release Form

I, irrevocably consent to any and all uses and displays of my 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 Metro Milwaukee 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, without any royalty, payment, or other compensation to me, 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 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 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.

I have read this Consent and Release Form completely and I fully understand what it means. I have not been offered any additional consideration or enticement, nor have I been coerced to sign this document. I am voluntarily signing it for the purposes and considerations described.

I agree to the Big Brothers Big Sisters Media Consent and Release Form.I do not agree to the Big Brothers Big Sisters Media Consent and Release Form.

Volunteer Full Name

Electronic Signature

I CONSENT TO AND UNDERSTAND THAT:

The references I listed may be contacted by mail, telephone or email.
Other Big Brothers Big Sisters agencies or youth organizations where I have worked or volunteered may be contacted as references.
I am in no way obligated to perform any volunteer services.
Big Brothers Big Sisters of Metro Milwaukee is not obligated to match me with a youth and may deny my application or close my match at any time, and to protect all participants’ confidentiality, BBBS is not required to disclose reasons for doing so;
I will be asked to provide my social security number and I may need to be fingerprinted.
Failure to disclose any arrest(s), charge(s) or conviction(s), will directly impact the agency’s decision to advance my enrollment application.
Information gained from background checks may be discussed with the potential or active Volunteer Big and then discussed with the Little's parent or guardian to ensure child safety.
As part of the enrollment process, I will be required to provide additional personal information, including completion of an in-person interview; prior to any recommendations for program acceptance.
In pursuit of funding or other partnership opportunity, Big Brothers Big Sisters of Metro Milwaukee may share that I am a volunteer with my employer or academic institution.
In the event of the agency’s determination of my ineligibility, reasons for non-acceptance will not be disclosed, in accordance with agency policy.
I understand the information I provide in the enrollment process will be kept confidential, unless disclosure is required by law.
- I understand that detailed accounts of child abuse or neglect, past or present, will be reported to proper authorities;
- I understand that certain relevant information about me will be discussed with the parent/guardian of a child who is a prospective match (this might include demographic information, information relevant to parent/child preferences, and any information relevant to a child’s safety or well-being);
It is my responsibility to update the agency if any of the information I provide on this application, in my interview, or any other information provided during the enrollment process changes (i.e. address, phone number, auto-insurance, new criminal charges, etc.).
I agree to complete questionnaires throughout my time in the program to evaluate and improve program services;
I agree to timely communication and follow-up with all agency staff as required by the agency.

PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING THIS APPLICATION
I understand that this is an application for a volunteer opportunity and is not a promise or commitment by Big Brothers Big Sisters.

I certify that all information I have provided or will provide to Big Brothers Big Sisters, including this application, is true, accurate, and complete to the best of my knowledge. I certify that I have and will answer all questions to the best of my ability and that I have not and will not withhold any information that would affect my application for a volunteer position. I understand that information contained in my application will be verified by Big Brothers Big Sisters.

I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant or my termination as a volunteer. At any time while involved with the Big Brothers Big Sisters program, I agree to immediately inform my Big Brothers Big Sisters contact person of any and all infractions, violations, charges, and convictions related to any civil, domestic, or criminal matters. I understand that BBBS staff needs to be fully informed to provide the best guidance or support possible. I have read and understand documents containing policies in the enrollment form including, but not limited to:

Non-discrimination Policy
Volunteer Rules and Responsibilities
Confidentiality Policy
Communicable Disease Policy
Weapons/Firearms Policy
Background Check Policy
Social Media Guidelines for Volunteers
Virtual Communication Platform Consent
Media Consent and Release Form

PLEASE NOTE - After submitting this form with the electronic signature on the next page, you will receive an email with a link to verify the signature. YOU MUST CLICK THE LINK TO VERIFY SUBMISSION IN ORDER FOR THE FORM TO BE COMPLETE.

Save my progress and resume later | Resume a previously saved form

Contact Information