• PARENT/YOUTH APPLICATION

    PARENT/YOUTH APPLICATION


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  • 5. Information regarding absent parent:

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  • For Big Brothers Big Sisters Community-Based Mentoring Programs: I hereby give my permission to release information regarding myself and/or my child to a volunteer Big Brother/Big Sister. This release applies to the referral source, school officials, counseling/health agencies, or Dept. of Human Services as it pertains to matching my child with a volunteer. I authorize my child’s school to release grades and attendance records to Big Brothers Big Sisters.

    I give my permission for Big Brothers Big Sisters of Flint & Genesee County, Big Brothers Big Sisters of America, and their funders to utilize any photos, audio tapes, video images or other images/recordings; academic achievement, school attendance for promotional, reporting and other purposes.

  • For Big Brothers Big Sisters After-School Program or Lunch Buddy Program: I give permission (1) for my child to participate in the Big Brothers Big Sisters Program; (2) for the school to provide social and academic information about my child to Big Brothers Big Sisters (e.g. report cards, behavior reports) and discuss the health of match relationship; (3) to have my child complete a questionnaire containing questions about school, home life, and personal interests; (4) to have my child talk with a Big Brothers Big Sisters staff person about personal safety; and (5) to use my child's photograph and first name for the purpose of publicity efforts by Big Brothers Big Sisters. I understand that all in-person contact between the child and volunteer will be at the child’s school only.

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  • Big Brothers Big Sisters of Flint & Genesee County 1176 Robert T. Longway Blvd. Flint, MI 48503 (810) 235-0617 Rev. 02/2020

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