Child/Youth Application: 2025 Summer Camp (Site Based Group Program)

Medical and Emergency Information

(If parent/guardian/caregiver can’t be reached then this person listed below is granted permission to pick up child/youth and/or authorize emergency treatment)
Name*

First NameLast Name
Relationship to Child/Youth:
Cell Number:*
Please enter a valid phone number.
Work Number (if applicable):
Please enter a valid phone number.
Physician's Name:
Child/Youth's Health Card Number:
Please note any health issues/medications/allergies/dietary restrictions to be aware of:*
Parent/Guardian Signature is required:
I, parent/guardian/caregiver First Name* Last Name* give Big Brothers Big Sisters of the Fraser Valley permission to pursue the application of my child/youth First Name* Last Name* . I understand the agency is under no obligation to accept or assign the application and is not required to divulge the reasons for this decision. I also acknowledge that the case file is the property of the agency.

I, the parent/guardian/caregiver of the above-mentioned youth, understand that all youth/children in the program must participate in the child safety training program, Strong from the Start, prior to participating in a mentoring program.

In case of accident, illness or surgical emergency to child and if I am not immediately available for consultation and consent, I HEREBY AUTHORIZE AND DIRECT the mentors to secure proper medical or other related treatment for the child/youth. Mentors will not be responsible for transportation of my child to hospital. If I am not available to transport the child/youth the mentor has permission to call for an ambulance. All costs incurred are the responsibility of the parent/guardian/caregiver.
Signature of Parent/Guardian/Caregiver*

Clear
Date

MonthDayYear
Date

How will your child/youth be getting home from the summer day camp program? Check off which ones apply.
Someone will be picking up the child/youth

YesNo (I give the child/youth permission to walk to/from the camp)
If yes, who has your permission and will be picking up the child/youth?

Informed Consent (Site-Based Group Program)

Parent/Guardian
Name of Parent/Guardian/Caregiver:*

First NameLast Name
Parent/Guardian Email:*
example@example.com
Region of Application:*

AbbotsfordChilliwack/Hope
I hereby give permission to Big Brothers Big Sisters of the Fraser Valley 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, however, where appropriate supervision takes place, the volunteer may be younger), 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 the Fraser Valley, 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 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 the Fraser Valley, 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 the Fraser Valley. I also agree that my child will participate in the Pre- Match Training Program administered by Big Brothers Big Sisters of the Fraser Valley.
I HAVE READ AND UNDERSTAND THIS AGREEMENT. BY SIGNING THIS AGREEMENT, I ACKNOWLEDGE THAT:
I, First Name* Last Name* , the parent/guardian/caregiver of First Name* Last Name* hereby request Big Brothers Big Sisters service for my child. I give my child/youth permission to participate in one or more group programs offered by Big Brothers Big Sisters of the Fraser Valley. I am aware of and understand the risks, dangers and hazards associated with the above service and agree such service is suitable for my child/youth.
Signed at Date
blanks
Signature of Parent/Guardian/Caregiver:*

Clear

Media Consent Form

Child/Youth
Name of Child/Youth:*

First NameLast Name
Region of Application:*

AbbotsfordChilliwack/Hope
I hereby*

Do Give ConsentDo NOT Give Consent
to Big Brothers Big Sisters of the Fraser Valley to use any photographs, audio and/or video recordings of my child/youth as taken or produced by media personnel and/or agency members and/or agency staff for the purposes of promotional material including brochures, audio visual productions and all social media promotion. I further waive any claim which I may have against Big Brothers Big Sisters of the Fraser Valley arising from the use of such photographs, audio and/or video recordings of my child/youth, as aforesaid.
Signature of Parent/Guardian/Caregiver:*

Clear
Name of Parent/Guardian/Caregiver:*

First NameLast Name
Date*

MonthDayYear
Date
Note: It is the parent/guardian’s responsibility to notify the office if the status of this consent changes.
Should be Empty:

Child/Youth Application

Medical and Emergency Information

Informed Consent (Site-Based Group Program)

I HAVE READ AND UNDERSTAND THIS AGREEMENT. BY SIGNING THIS AGREEMENT, I ACKNOWLEDGE THAT:

Media Consent Form