ENROLL A CHILD TODAY!

APPLY ONLINE

Complete the online application below to get started!

Enrollment Information

Child's First Name

Child's Last Name

Child's Date of Birth

mm/dd/yyyy

Parent/Guardian First Name

Parent/Guardian Last Name

Street Address

City

State

Zip

County of Residence

Other County

Mobile Phone

Secondary Phone

Preferred Contact Method

Child's Racial Indicator

How would you define your child in terms of race?

Does the child's primary guardian speak English?

What language(s) does the primary guardian speak?:

Child's Gender

Preferred Pronouns

How would you define yourself in terms of gender?

Are you open to a Big Sister being paired with your son?

Yes- I would be open to thisNo - I would like my child to have a Big Brother

Does this child have siblings enrolled in Big Brothers Big Sisters?

If yes, what are those siblings names?

Child Living Situation

Child's School

Child's Current Grade Level

(2023-2024)

Child's High School Graduation Year (click here to accurately calculate your child's graduation year)

ex: 2032

Was your child eligible to receive Free/Reduced Lunch in the 2023-24 school year?

Military Families: Does your child have a parent in the military?

Is your child a NAZ scholar? (Enrolled in the Northside Achievement Zone)

YesNo

Northside Achievement Zone Release of Information

I give my permission for Big Brothers Big Sisters to share information with Northside Achievement Zone regarding my child's match and BBBS program participation.

I have read the terms above and agree

Type Signature Here:

Your Information

Your Full Name

What is your relationship to this Child?

Organization/School Name/Relationship to Student:

Email Address:

Phone Number:

In order to move forward in the enrollment process, we must have consent from the child's parent or legal guardian. Please affirm below that the parent/guardian is aware this application is being submitted:

Emergency Contact Information

Emergency Contact Full Name (If possible, please list someone other than yourself.)

Emergency Contact Relationship to Child

Emergency Contact Phone Number

How Did You Find Us?

How did you hear about Big Brothers Big Sisters?

Please choose the most recent occurrence

Where did you hear about us?

BBBSTC POLICIES AND PERMISSIONS

Privacy and Confidentiality Policies and Permissions

Big Brothers Big Sisters Twin Cities (BBBSTC) respects the confidentiality of program participant and volunteer records and, with the exception of situations listed below, shares information about program participants and volunteers only with BBBSTC staff members, certified volunteers, and interns. Identifying information will be released to other individuals or non-BBBS organizations only with the parent’s/guardian’s written consent. All records are considered the property of BBBSTC and not the agency workers or program participants or volunteers themselves.

Confidentiality exceptions include the following:

1. For purposes of program evaluation, audit, or accreditation, and with the prior approval of the Board of Directors, certain outside bodies such as Big Brothers Big Sisters of America may

have access to child and volunteer records.

2. Members of the Board of Directors or external evaluators have access to child and volunteer files upon authorization of the Board of Directors.

3. Written information shall only be provided to law enforcement officials or the courts in

response to a valid and enforceable subpoena.

4. Information shall be provided to an agency’s legal counsel in the event of litigation or

potential litigation involving the agency.

5. State law mandates that suspected child abuse be reported to the appropriate authorities (local police or child protection agency).

6. If an agency worker/representative receives information indicating that a child or volunteer

may be dangerous to himself or herself or to others, necessary steps may be taken to protect

the appropriate party. This may include a medical referral or report to the local law

enforcement authorities.

7. At the time a child or volunteer is considered as a match candidate, information is shared

between the prospective match parties. Match parties are expected to respect and keep

confidential such shared information. The information about the volunteer may include such

items as: age, sex, race, religion, interests, hobbies, marriage, family status, sexual orientation, living situation, etc.

8. Information shared about the child may include such items as age, sex, race, religion, interests, hobbies, family situation, etc.

I have read the confidentiality policy listed above. I agree to program participation under the conditions set forth:

Program Participation Policy and Permissions

I give permission for my child to participate in the Big Brothers Big Sisters program. I understand that the BBBS agency 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 personal information. I understand that my child and I will be asked to provide additional personal information about school, home, interests, safety, etc. Upon acceptance into the program, information gathered will be used to place my child in a match relationship with a volunteer. I have read the program description and understand the agency’s guidelines and expectations for myself and my child in a match relationship through BBBSTC. I authorize BBBSTC to talk to my child about their personal safety and respond to sensitive topics in a professional manner. If my child is matched with a Big Brother or Sister, I agree to support my child’s match and to immediately report any concerns I might have to the Big Brothers Big Sisters staff.

I have read and understand the agency policy with respect to confidentiality of child records listed above. I agree to program participation under the conditions set forth.

Social Media Policy and Permissions

BBBSTC recognizes and appreciates the role of online media and social networking in today’s society. Before my child engages in any online activities with his/her Big Brother or Big Sister, I understand that I must give my permission.

I have read the social media policy. I agree to program participation under the conditions set forth.

Photo/Video Permission

I hereby give my permission for BBBSTC to use identifying information (first name, photograph, match profile information) regarding my child now, and in the future, for agency publications, media productions, promotional materials, and online social networking media (social media, blog post stories, inspirational videos, etc.) This publication consent will expire upon my giving written notification to BBBSTC. This revocation will not apply to existing publications or productions in stock for distribution. Last names of minors (Littles or High-School Bigs) will not be used in any BBBSTC publication without further written or verbal consent by the minor’s parent or legal guardian. (Please note BBBSTC encourages other media entities to abide by this policy, but ultimately, BBBSTC is not responsible for external publicity.)

Media Consent Permission based on the above policy:

Online and In-Person Options

At this time, you have the option to conduct your interview and match introduction in-person or virtually. We are monitoring the status of the pandemic and will adjust this policy as needed based on state and local guidance. We appreciate your willingness to adapt with us as we continue to create more life-changing relationships in our community.

If you have questions about this or any other program policies, please email us here: thinkbig@bigstwincities.org

I have read all the terms above and agree

Type Signature Here:

Questions? Click here.