• Young Person/Taiohi Application to have a Big Brother Big Sister Mentor/Tuakana

    Please note: We require this application to be completed by a Parent/Caregiver/Kaitiaki. While third parties can support Parents/Caregivers/Kaitiaki to complete the application, they cannot submit the form independently.
  • Please select your regional/rohe Big Brothers Big Sisters branch

  • We are currently not taking online child referrals at this branch. This can be due to a different intake procedure or a full waitlist. Contact the branch for more information. "branch"@bbbs.nz

    Sorry for the inconvenience.
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  • Unfortunately, we are unable to receive referrals for young people aged 13 and over.

  • Young person/Taiohi gender*

  • Primary Parent/Caregiver/Kaitiaki Details

  • Is there a second parent /caregiver/kaitiaki who lives at the same address/kāinga noho?
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  • Are you in paid work/mahi?*
  • Can we call you at your work/mahi?
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  • Do you expect to live in the area/rohe for the next few years?*

  • Other Parent / Caregiver

    (not providing day-to-day care)
  • Does the young person/taiohi have another parent / caregiver who lives at a different address?
  • Where appropriate, it is our preference for both parents to be aware of, and in agreement/whakaaetanga with an application to the programme. This ensures the best possible outcome for your young person/taiohi and the mentor/tuakana. Is the other parent aware of your application?

  • Key Relationships/whanaungatanga

  • Are other agencies involved with your young person/taiohi? Has your young person/taiohi ever seen or now seeing a psychologist, social worker, therapist, counsellor etc.?*

  • School/Kura Details

  • Does your young person/taiohi seem interested in school/kura?*
  • Does your young person/taiohi get into trouble/raru at school/kura?*
  • Is/has your young person/taiohi been involved in a special education programme?*

  • More about the Young Person/Taiohi

  • Have you talked to your young person/taiohi about having a mentor/tuakana? Do they want a mentor/tuakana?*
  • How would you describe your young person's/taiohi activity levels?*
  • How would you describe your young person's/taiohi strength/personality?*
  • What are your young person/taiohi's interests*
  • Please list the kinds of activities your young person/taiohi already participates in or would like to do with a mentor/tuakana*

  • I understand/ Kei te mohio ahau that:

    •  My participation/whai wāhi, and my child's participation/whai wāhitanga, in the programme is entirely voluntary and I am free to withdraw my child/tamariki at any time.
    • This consent/whakaae form is effective for the duration of my child's/tamariki involvement in the Big Brothers Big Sisters programme.
    • There are a limited number of mentors/tuakana available, and my child/tamariki may be placed on a waitlist for a mentor/tuakana.
    • All my information and anything I tell Big Brothers Big Sisters Staff will remain confidential unless it is a matter of Health and Safety.  I have the right to have access to, or have corrected, any information held by the programme about myself or my young child/tamariki.
    • As part of the ‘match’ support the Mentoring Coordinator/Kairuruku will maintain regular contact with my child/tamariki, myself and the mentor/tuakana. 
    • Non-identifying information provided by me during these contacts may be used for the purposes of programme evaluation and development.

    Photo/Press/Website Release

    From time to time, photos of the mentor/tuakana and the young person/taiohi (together or individually) participating in Big Brothers Big Sisters activities are used to raise awareness and support for our programmes particularly to recruit more volunteers. This may include use of photos in community newspapers, on our websites/social media, on display or billboards at BBBS events, and in our newsletter

  • I consent to photographs/videos of my child/tamariki and to their first name/ingoa being used for Big Brothers Big Sisters publicity and promotional purposes. Such photos might include a photo celebrating their match anniversary or of them participating in match or BBBS activities.*
  • Rows
  • I do(aē) / do not (koē) consent/whakaae to Big Brothers Big Sisters contacting teachers /ako and other professionals who may work with your young person/taiohi for information about how a mentor/tuakana can be most helpful.*

  • I give permission for my child/tamariki to participate in the Big Brothers Big Sisters Mentoring Programme. I agree to inform Big Brothers Big Sisters of any change in circumstances, including medical conditions or contact details, which may affect my child’s/tamariki involvement in the mentoring programme.
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