I hereby give permission to Big Brothers Big Sisters of South Durham and Northumberland (“BBBSSDN” or “the agency”) 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 mentoring program led by a responsible adult Mentor/Staff (minimum 18 years old, however, where appropriate supervision takes place, the volunteer may be younger). I understand that all efforts will be made to select a responsible Mentor to facilitate the group program. All Mentors are carefully screened and receive comprehensive training from the agency prior to facilitating the group.
BBBSSDN group programs that may currently be running include Go Girls!, Switch Gears, The Little Studio, and Power Play. For more information about our programs, please visit our website at: https://durhamnorthumberland.bigbrothersbigsisters.ca/
In consideration for this service to my child by BBBSSDN, 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 (“BBBSC”) 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 BBBSSDN, with the group facilitator so that my child’s needs may be best met.
Confidential information about me or my child will not be disclosed or used except as outlined above, and in accordance with statutory requirements, including but not limited to the Education Act, the Municipal Freedom of Information and Protection Act, and the Child, Youth and Family Services Act.
I understand that this application is the property of BBBSSDN. I also agree that my child will participate in the BBBSC child safety training program: Pre-Match Training. Pre-Match Training is administered by the agency and provides important information to participants to ensure that child safety is the priority.
hereby request Big Brothers Big Sisters service for my child. I give my child permission to participate in this group program offered by BBBSSDN for the designated length of the program. Should I wish to register my child for more than one BBBSSDN program, I understand that I must complete a new Agreement. I am aware of and understand that there may be risks associated with the above service and agree such service is suitable for my child. I am aware that I can contact BBBSSDN Program Staff to ensure that I have a thorough understanding of the service and the benefits of my child’s participation in the program.
