Bigs on Campus Registration Form

  • Thank you for your interest in Bigs on Campus. Once your submission has been reviewed by our team, you will receive an email confirmation with more details about the program.

  • PERSONAL INFORMATION

  • MM slash DD slash YYYY
  • This response is voluntary and will be used for statistical purposes only.
  • This response is voluntary and will be used for statistical purposes only.
  • EMERGENCY/ALTERNATE CONTACT

  • Please provide an alternate contact to call in case of emergency.
  • ADDITIONAL INFORMATION

  • We realize that this information can be of a sensitive nature and it will be treated with confidence and respect.
  • Ex. religious or cultural views, stressors, other existing issues?
  • PROGRAM SITE

  • Please note that guardians are responsible for pick-up and drop off.
  • Media Consent

  • Please select your response to the Media Consent statement listed above.
  • Informed Consent

  • I have read and understand this agreement. By checking YES, I acknowledge that I am the parent/guardian of the child for whom I am applying and that I hereby request Big Brothers Big Sisters service for my child. I give my child permission to participate in one or more group programs offered by BBBSP. 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.
  • Parent/Guardian Signature