BBBS/BB Youth Application & Parent/Guardian Permission Form

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Commitment + Communication Policy
Community-Based Program Requirements:
  • We ask for a 1-year commitment from the time your child/youth is matched.
  • Your child/youth and their Big will meet weekly or biweekly, depending on volunteer’s and family’s schedules. 
  • For the first year of the match, support contacts with volunteer, child, and parent/guardian will follow a monthly cycle, moving to every three months after the one-year anniversary of the match. The contact may take place by phone, email, text or in person.

School- and Site-Based Program Requirements:
  • We ask for a 1-year commitment from the time your child/youth is matched.
  • Your child/youth and their Big will meet weekly at school, in an after-school program, or at a designated site. 
  • For the first year of the match, contacts with the Big and Little will follow a monthly cycle, moving to every three months after the one-year anniversary of the match. Contact with the parent/guardian will be within the first two weeks of the match and twice yearly thereafter. The contact may take place by phone, email, text or in person.
Program Information
COMMUNITY-BASED PROGRAM   Bigs and Littles meet two to four times a month when and where it's convenient for both of them. Movies, crafts, hiking, or just hanging out – it's up to the Big and Little.

SCHOOL-BASED PROGRAM   Bigs and Littles meet at the same time and location each week for approximately one hour – during lunch or after-school. They might share a lunch hour, work on a project, or just have good conversation! 

BOWDOIN BEARS AND CUBS (SITE-BASED)   In partnership with Bowdoin College, Bowdoin student Bigs meet with Littles approximately 6 times each semester on a Sundays during the academic year.Activities include games, crafts, sports, swimming, projects and more!

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. 
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

Hold CTRL+F to select multiple
This is the year the youth will graduate.
Guardian Information
Type NA if unemployed
Family Information

Physical Address

Parent/Guardian Agreement

By checking the box below and providing my signature at the end of this form, 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 to provide social and academic information about my child to Big Brothers Big Sisters (e.g. report cards, behavior reports);
  4. 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;
  5. To have my child talk with a Big Brothers Big Sisters 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. 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). 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 Bath/Brunswick 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, againstBig Brothers Big Sisters of Bath/Brunswick, 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.

Additional Information

Additional Information



Other Siblings and Relatives in the Program
Please choose this child's relationship to the following people:





























We will make every effort to honor your preferences for your child's mentor. BBBS does not discriminate on the basis of race, ethnicity, gender, gender presentation, marital status, sexual orientation, or religion.

Photo Consent and Release Form

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 BBBS of Bath/Brunswick 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. 

 

Permission to Participate in Media & Publicity Efforts: 

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

Confidentiality Policy

Confidentiality Policy Summary

TO BE READ AND SIGNED BY  PARENTS/GUARDIANS

In order for Big Brothers Big Sisters of Bath/Brunswick to provide a responsible and professional service it is necessary for clients, parents/guardians, and volunteers to share personal information about themselves and their families. BBBS keeps this information confidential, with special exceptions listed below. In all cases, any information will be shared only among the agency’s professional staff. The right to confidentiality includes written records, video, film, pictures and use of the client’s or volunteer’s name in agency publication or displays.


Limits of Confidentiality


1. Information will be released to other individuals or organizations only after a “Consent to Release Information” form is signed by the volunteer, client or client’s guardian. Written consent will not be necessary in emergency situations, situations that are reportable by law (such as abuse or neglect situations), or in court cases demanding information through subpoenas or court orders.


2. Information identifying clients and volunteers may be used in agency publications or promotional materials only after the individuals have given their written permission.


3. Case records may be made available to the Board of Directors and/or Big Brothers Big Sisters of America for purposes of program evaluation, audit, or accreditation.


4. Maine State Law requires that suspected abuse, neglect or abandonment of any child be reported to the Department of Health and Human Services. All personnel, including paid professional staff and volunteers, are required to notify the appropriate supervisor immediately if abuse or neglect is suspected.


5. If any agency worker receives information indicating that a client or volunteer was dangerous to themselves or others, necessary steps shall be taken to protect the appropriate party. This may include a medical referral or a report to the local law enforcement authorities.


6. The nature of services provided by BBBS requires that confidential information about potential Bigs or Littles be shared between client, guardian, and volunteer prior to a match meeting. The information revealed is provided as a profile and includes only information which is relevant to the individual’s present circumstances and behavior. No identifying facts (name, address, etc.) are shared until all parties' consent to the match. The only exception to this is when the caseworker suspects the proposed match parties may already know each other; in this case it would be necessary to exchange names first. Then, if there are no objections to the match, profile information will be shared.

Activity Interest Form
To be completed by child. This form helps us get to know you better and provides us with valuable information we can use to make the best match for you. Please check the box next to each activity you like.
Additional questions
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Contact Information