Virtual Group Mentoring Program Application
To enroll a young person in our Virtual Group Mentoring Programs, please complete the fields below. We will follow up within three business days regarding your application.
If you are applying using a mobile device, please select program of most interest. If you are using a PC, you may multi-select by holding Ctrl.
EMERGENCY CONTACT INFORMATION
INFORMED CONSENT (VIRTUAL GROUP PROGRAM) - PARENT
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.
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.
Insert parent/guardian's first and last name.
Insert child's first and last name.
I provide my consent for Big Brothers Big Sisters of Halton and Hamilton to take photos/videos of my child during the program which can be used for marketing or public relations purposes in the future.
Please write your name in full to confirm your consent.
Please indicate today's date.