Youth Enrollment Form - School-based

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School-based Mentoring Program
Before starting the Youth Enrollment Form for our School-based Program, please take a moment to review the program expectations and confirm that you can support the Youth’s commitment to the following:
  • Youth and Parents/Guardians in this program are recommended to utilize our Big Brothers Big Sisters Communication Platform to message their Bigs and Support staff where it is age appropriate.
  • Youth in this program are expected to meet once per week during the school year. This time may be during the school day or after school hours depending on the youth and volunteer Big’s schedule. This meeting may utilize a virtual meeting platform as needed.
  • Youth and Parents/Guardians in this program will be asked to complete surveys and check-ins with their Big Brothers Big Sisters Support Staff.
Non-Discrimination Policy
Our funders require that we collect the information in this form. It will not affect the youth’s enrollment.

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.
Hidden Fields
To look up the owner's email for notifications
For notifications
Youth Information
Enter a date in the following format: mm/dd/yyyy
This is the year the youth will graduate.
Press CTRL while choosing to select multiple
Type NA if none




Guardian Information
Type NA if unemployed
Family Information

Existing Household Members
Please choose this child's relationship to the following people:


Emergency Contact
Please list additional adult(s) living in household first.

Youth Personality Profile

Parent/Guardian Rules and Responsibilities
Your child has asked to participate in the Big Brothers Big Sisters (BBBS) mentoring program at his/her school. What’s the benefit?

BBBS children achieve:
  • Educational success, including grade promotion, high school graduation, and college readiness.
  • Avoidance of risky behavior, including tobacco, drug, and alcohol use; skipping school and breaking school rules; crime and violence towards others.
  • Social and emotional skill development, leading to higher aspirations, greater confidence, and better relationships.
What will a “Big” do?
  • Help your child with school work.
  • Play games and sports, do arts and crafts.
  • Spend time talking and hanging out.
How do I sign up my child?
  • Complete, electronically sign, and submit this Youth Enrollment Form.
What happens next?
  • Big Brothers Big Sisters (BBBS) staff will interview your child to learn more about his/her personality and interests. This helps us match your child with the right mentor.
  • BBBS will carefully screen—including criminal background checks—the adult volunteer who will be working with your child.
  • When an appropriate volunteer has been found for your child, BBBS will introduce your child to his/her “Big” at school. Soon after, you will receive a letter with details of the match and staff contact information.
  • BBBS will supervise and support the Big/Little match as they work together during the school year.
  • BBBS staff will contact you three times a year to discuss progress and share updates.
Matching
  • Bigs and Littles are paired based on common personalities and interests. If you have preferences regarding your child’s Big, please notify Big Brothers Big Sisters (BBBS) staff.
  • Little Sisters will be matched to Big Sisters only.
  • Little Brothers over the age of 12 will be matched to Big Brothers only. Little Brothers under the age of 12 can be matched to Big Brothers or Big Sisters.
Mentoring Time
  • Bigs and Littles will work on homework, play games and enjoy interactive educational activities during one of our scheduled on-site mentoring times.
  • Matches must remain on school grounds in approved areas at all times.
  • Parents/caregivers are welcome to come to match meetings at any time! This is a great opportunity to see first-hand what your child is working on and to meet your child’s Big.
  • Bigs and Littles will meet one hour per week during the school year for at least four semesters.
  • If your child cannot make their assigned mentoring time, contact your School-based Coordinator immediately.
Match Support
  • To ensure long and strong relationships, BBBS staff will regularly speak with your child, his/her Big and school staff to ensure a safe, enjoyable experience and measure progress.
  • BBBS staff will contact parents/caregivers once each semester and once over the summer to share updates and discuss progress. Please return calls/emails from BBBS staff within three business days.
  • Please ensure your contact information is up to date at all times.
  • If at any time, you have questions or concerns regarding your child’s match, do not hesitate to contact BBBS staff.
Winter and Summer Bridge Activities:
  • Bigs, Littles and their families are encouraged to participate in BBBS events that take place during winter and summer breaks. It is mandatory that Littles attend with their caregivers. Bigs are allowed to meet their Little and their family at the events.
  • Bigs and Littles are encouraged to participate in our summer writing program, which enables matches to stay connected when they are not meeting. BBBS will provide all of the necessary materials.
I indicate that I have reviewed the agency rules and policies , and I understand and agree to my responsibilities as discussed. 
Parent/Guardian Acknowledgement

Medical Release

I authorize Big Brothers Big Sisters (BBBS) employees, and/or BBBS volunteers to consent to such medical and/or surgical treatment as he/she deems necessary for my child in case of emergency, illness of my child, or accident involving my child. If possible under the circumstances, these medical services are to be performed by the below named physician or facility.
Parent/Guardian Acknowledgement

Virtual Communication Platform Consent

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

I consent for the youth to having contact with his or her Big and/or BBBS staff through Big Brothers Big Sisters' digital platform.
COPPA PARENTAL CONSENT FORM
Notice to Parents in compliance with the Children’s Online Privacy Protection Act (COPPA), parents (or legal guardians) of children under 13 years of age must consent to collections, uses and disclosures of the personal information of their children collected by Big Brothers Big Sisters of Metro Milwaukee (BBBSMM) on BBBSMM and NATIONAL websites, including bbbsmilwaukee.org, bbbs.org, MatchConnect, bbbsa.force.com, forms.bbbs.org and formstack.io. BBBSMM COPPA statement is incorporated in the website Privacy Policy here. BBBSMM may have collected your online contact information from your child, as well as the name of the child or the parent, in order to obtain your consent. Your permission is required for the collection, use, or disclosure of your child’s personal information. We will not grant your child access to any BBBS website account unless you provide us with permission. BBBS website accounts provide access to BBBS content, materials, and resources relating to BBBS programs and activities, including information pertaining to [MATCHES ETC.]

You have the right to revoke your consent at any time for the collection and use of your child’s information. If you would like to revoke your consent, please provide a written, signed statement of revocation and mail it to: Big Brothers Big Sisters of Metro Milwaukee, 788 N Jefferson Street Suite 600, Milwaukee, WI 53202.
Parent/Guardian Acknowledgement

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.

I have read and understand the above document which summarizes the agency policy of confidentiality of client records. I agree to abide by the conditions it sets forth.
Parent/Guardian Acknowledgement

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.
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.
Parent/Guardian Acknowledgement

Media Release and Consent Form

I, as the legal parent or guardian of the child listed below, 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 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 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.

I have read this Media 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.
Youth's Name
Parent/Guardian Acknowledgement

Electronic Signature

I give permission:
  • for the youth to participate in the Big Brothers Big Sisters of Metro Milwaukee (BBBS) program.
  • for the youth to complete surveys containing questions about topics including personal interests, peer relationships, feelings about school, grades, educational expectations, parental relationships, home life and attitudes toward risky behaviors.
  • for the youth's school to release information about academic performance, behavior and grades to BBBS.
I understand that:
  • BBBS is not obligated to match the youth with a volunteer.
  • As part of the enrollment process the youth and I will be asked to provide additional personal information about the youth and my family.
  • BBBS may share pertinent information with a volunteer to appropriately match the youth.
  • If the youth is matched with a Big Brother or Big Sister I will support the match and immediately report any concerns I might have to the BBBS staff.
  • Neither the agency nor the volunteer assumes legal or financial responsibility.
  • BBBS staff are mandated reporters. This means BBBS is required by law to report any signs of child abuse or neglect.
I acknowledge that I have completed this enrollment form and that all information is correct to the best of my knowledge.

I have read and understand documents containing policies in the enrollment form including, but not limited to:
  • Non-discrimination Policy
  • Parent/Guardian Rules and Responsibilities
  • Medical Release
  • Virtual Communication Platform Consent
  • Confidentiality Policy
  • Communicable Disease Policy
  • Media Release
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.
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