Big Bunch Registration Mentee

  • Date Format: MM slash DD slash YYYY
  • Please provide the best email address to send information about Big Bunch activities to.
  • MEDIA CONSENT

    IMPORTANT NOTE: Recording of audio/video, and/or screen capturing of online activities are prohibited for anyone outside of BBBSY staff. Any individual failing to comply will be permanently removed from the group and their agency file will be closed. Please help us respect and maintain the privacy of the children, families, and mentors who are excited to take part in these virtual activities.
  • I hereby consent to Big Brothers Big Sisters of York (BBBSY), the use of any photographs, audio and/or video recordings of my child taken during the program as authorized by the BBBSY President & CEO or Board of Directors. I give my permission for this media to be used by BBBSY for purposes of promotional material including brochures, posters, newsletters, media information, advertisements, audio-visual productions and digital media, (such as the BBBSY website and social media). Photographs or video productions may also be shared with community and school partners for program promotion.
  • INFORMED CONSENT

  • I hereby give permission to Big Brothers Big Sisters of York (BBBSY) to make available their service to my child. It is my understanding that the intention of the Agency is to offer my child an opportunity to participate in a group program lead by a responsible adult, (minimum 18 years old), I understand that all efforts will be made to select a responsible Mentor who will facilitate the group program. In consideration for this service and other valuable consideration provided to my child by BBBSY, 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 BBBSY, with the group facilitator so that my child’s needs may be best met. I understand that this application is the property of BBBSY. I also agree that my child will participate in the Pre- Match Training Program administered by BBBSY if they have not done so already.