Client Application – Group Programs

To enroll a young person in our Group Mentoring Programs, please complete the fields below. We will follow up within three business days regarding your application.

I hereby give permission to Big Brothers Big Sisters of Halton and Hamilton 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 Big Brothers Big Sisters of Halton and Hamilton, 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 (which includes, but may not limited to, the application package and attendance forms) 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 Halton and Hamilton, with the group facilitator so that my child’s needs may be best met. Finally, I understand that Big Brothers Big Sisters of Halton and Hamilton will be evaluating the program and that my child will contribute to the data because of participating in the program. This data will be used to help improve future programming and demonstrate outcomes to our funders. I agree that my child can participate in evaluation activities as part of the program (note: your child’s identity will be protected and will not be shared beyond program administrators; all data and reports produced will be aggregated and summarized so your child will remain anonymous to the readers and their data kept confidential). I understand that this application is the property of Big Brothers Big Sisters of Halton and Hamilton. I also agree that my child will participate in the Pre- Match Training Program administered by an employee of Big Brothers Big Sisters of Halton and Hamilton or a school designate.

To better promote our cause at Big Brothers Big Sisters of Halton and Hamilton, this year and future years we try to collect student testimonials to raise awareness about our program, help the community to build a personal connection with our work, and to encourage potential new donors to give so that more amazing youth can continue to participate in the Program in the future. Audio and video footage is not taken during In-School programming, it is used for community programming only. Footage received during interactions with your child (video, audio, photo and/or written format) may be used for: Sharing student stories on our website media gallery; Promotional materials for the organization in print and digital form (e.g., annual reports, newsletters); Shown in meetings with charity stakeholders or potential funders to support the cause; By the media for their own publications (e.g., newspapers, online news sites, social media); By agents or servants of the Big Brothers Big Sisters to promote their work; Evaluation reports for funders We are asking for your permission to take footage of your child in video, audio, photo and written format for the uses described above which may include sharing on the World Wide Web and accessible to the public. Only your child’s first name will be used on any promotional materials.