By signing below, I certify that all of the information entered on this application is true and correct. Further, I give permission:
1. For my child to participate in the Big Brothers Big Sisters of Washington County (BBBS) program;
2. For the volunteer matched with my child, who has been screened and approved by BBBS, to transport my child to events and match activities;
3. For the school to provide social and academic information about my child to BBBS (e.g., report cards, behavior reports);
4. To have my child participate in an intake interview conducted by BBBS staff and complete questionnaires throughout his/her time in the program containing questions about school, home life and personal interests;
5. To have my child talk with a BBBS staff person about personal safety;
6. 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 and with exceptions noted. I understand that incidents of child abuse or neglect, past or present, must 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).
I do hereby release the organization and its employees, agents, members, volunteers and all other persons on its behalf from any and all liability for any damage or injury which such child might sustain while participating 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 his/her guardian. 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/Sister, I agree to support my child’s match by reviewing the program and safety information given to me by BBBS, communicating with BBBS 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 BBBS staff.