Family Application

I hereby make formal application to Big Brothers of Greater Vancouver to make available their service to my child. It is my understanding that the intention of the Agency is to match a responsible adult, (minimum 18 years old, however, where appropriate supervision takes place, the volunteer may be younger), with my child
for the purposes of shared activities, friendship and support. I understand that all efforts will be made to select a Mentor who is compatible with my child.

In consideration for this service and other valuable consideration provided to my child by Big Brothers of Greater Vancouver, 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 consent to Big Brothers of Greater Vancouver contacting any referring professionals involved with my family to obtain information for the purpose of assessing my application for a Mentor.

I further agree that all or part of the information herein may be shared, at the discretion of Big Brothers of Greater Vancouver, with my child’s Mentor, and/or with the referring professional, so that my child’s needs in a Mentoring relationship may be best met. 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 understand that I am under no obligation to accept a Mentor for my child, that the Agency is under no obligation to provide my child with a Mentor and that this application is the property of Big Brothers of Greater Vancouver. I also agree that I and my child will participate in the Pre-Match Training Program administered by Big Brothers of Greater Vancouver.