In-School Mentoring Forms (Child/Youth)

Informed Consent (Site-Based 1:1 Program) - Parent
I hereby make formal application to Big Brothers Big Sisters of Guelph (BBBSG) to make available their service to my child. It is my understanding that the intention of BBBSG is to match a responsible male/female adult, (minimum 18 years old, however, where appropriate supervision takes place, the volunteer may be younger), with my child for the purposes of shared activities, friendship and support. I understand that all efforts will be made to select a Mentor who is compatible with my child.

In consideration for this service and other valuable consideration provided to my child by Big Brothers Big Sisters of Guelph, I release the agency of all responsibilities and liabilities in connection to their services provided in good faith, to myself or my child. I permit the agency to release any relevant information, including my personal information, to Big Brothers Big Sisters of Canada and their insurers, as may be appropriate in connection with any legal proceeding, inquiry or risk thereof.

I understand that the collection of personal information about me or my child will be held in strict confidence and is to be used solely for the purposes of administering the program. I further agree that information about my child may be shared, at the discretion of Big Brothers Big Sisters of Guelph, with my child’s Mentor so that my child’s needs in a Mentoring relationship may be best met.

I understand that I am under no obligation to accept a Mentor for my child, that the Agency is under no obligation to provide my child with a Mentor and that this application is the property of Big Brothers Big Sisters of Guelph. I also agree that my child will participate in the Pre- Match Training Program administered by Big Brothers Big Sisters of Guelph and the school liaison.
Check below:*
- I HAVE READ AND UNDERSTAND THIS AGREEMENT. BY SIGNING THIS AGREEMENT, I ACKNOWLEDGE THAT: I hereby request Big Brothers Big Sisters service for my child. I give the agency my consent to assign a Mentor to my child. I am aware of and understand the risks, dangers and hazards associated with the above service and agree such service is suitable for my child.
Date*
MM slash DD slash YYYY
Parent/Guardian Name*
First Last
Parent/Guardian Signature*
SMS Verification*

Media Consent Form - Child/Youth
Name of Child/Youth*
First Last
Name of Agency at which child/youth is enrolled (Local Agency)*
I hereby consent to Big Brothers Big Sisters of Canada (National Office) and its associated member Big Brothers Big Sisters of Guelph the use of any photographs, audio and/or video recordings of my child or youth as taken or produced by media personnel and/or National Office or Local Agency staff at recreational events or match outings, or otherwise authorized by the National President & CEO, local agency President/Executive Director/CEO or Board of Directors, and that this media may be used by Local Agency and/or by the National Office for purposes of promotional material including brochures, posters, newsletters, media information, advertisements, audio-visual productions and digital media, (such as the local agency websites and social media). Photographs or video productions may also be shared with community and school partners for program promotion.*
- Please check here if you consent to the above.
- Please check here if you do not want your picture or your child’s picture used or if you have a safety concern.
Date*
MM slash DD slash YYYY
Parent/Guardian Name*
First Last
Signature of Parent/Guardian*
Note: It is the parent/guardian's responsibility to notify the office if the status of this consent changes.
SMS Verification*
Name
This field is for validation purposes and should be left unchanged.

In-School Mentoring Application

Step 1 of 3

Child's Information

Parent/Caregiver/Family Information

Getting to Know Your Child

Choosing a Mentor

Your Involvement

Informed Consent (Site-Based 1:1 Program) - Parent

Media Consent Form - Child/Youth