Enroll a child
Please complete all fields with the parent or legal guardian's contact information and submit the request below. A representative from your local Big Brothers Big Sisters of Greater Lafayette will contact you to begin the enrollment process shortly.We serve Tippecanoe, White, Benton, Warren, Fountain and Montgomery counties in Indiana. Not in our area?
Customer Details:
Parent/Guardian's Name
*
First Name
Last Name
Parent/Guardian's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian's Phone Number
*
Parent/Guardian's E-mail
*
example@example.com
Type of Phone
Please Select
Home
Cell
Mobile
Child's Gender
Male
Female
Child's Birthdate
-
Month
-
Day
Year
Date
How did you hear about BBBS?
Social Media
Radio
Google Search
Newsletter
Word of Mouth
BBBS Event
Other
Please verify that you are human
*
Submit
Should be Empty: