Teen Mentor Application - 2018 Step 1 of 7 14% Big Brothers of Greater Vancouver embodies the principles of diversity and welcomes participation regardless of race, religion, culture or sexual orientation.Thank you for your interest in applying to volunteer for Big Brothers of Greater Vancouver. We're so excited to learn more about you! There are so many children who are waiting for a mentor like you - and we can't thank you enough for taking the time to fill out this application form, so that we can find the best match for you. We kindly ask that you do not enter "n/a" anywhere on your application as this can delay the processing of your application. Please note that we only offer the Teen Mentoring program at select schools across the Lower Mainland and Sea to Sky regions which are listed on your application. Please select which high school you currently attend*A.R. MacNeill Secondary SchoolByrne Creek Community SchoolBurnaby Mountain Secondary SchoolCarson Graham Secondary SchoolDr. Charles Best Secondary SchoolGuildford Park Secondary SchoolJohnston Heights Secondary SchoolKillarney Secondary School (Only accepting mentors for Cook Elementary)L.A. Matheson Secondary SchoolLord Byng Secondary SchoolPrincess Margaret Secondary SchoolSir Winston Churchill Secondary SchoolTamanawis Secondary SchoolNone of the aboveThe program runs from September to May/June. Can you commit to spending one hour once a week as a Teen Mentor for the entire school year?*YesNoPlease explain why you cannot commit to the program for the full school year.*Does your parent/guardian know you are applying to become a Teen Mentor?*YesNoAt the end of this application, you will be asked to enter your parent/guardian's e-mail address. We require your parent/guardian's consent to complete your application. Your parent/guardian will receive our Volunteer Permission and Release agreement and be asked to read it over with you, sign it and email it back to us within 24 hours of receipt. Without receiving this form from parent/guardian, we will not be able to process your application. You will be asked to provide two references (one from school, and one personal) that know you well and are 19 years of age or older. The personal reference must have known you for a minimum of 2 years. You must be able to provide the email address of your references to complete this application. Do you have their email address on hand and are your references aware of your application?*YesNoPlease notify your references of your application ASAPOur agency will be contacting them via email in regards to your application as soon as we receive a parent consent from your guardian.Unfortunately, we do not currently offer Teen Mentoring program at your school.Unfortunately we cannot accept your applicationWe require your parent/guardian's consent to complete your application. Please apply once your parent/guardian has consented to your participation. Please make sure that you have notified your references that our agency will be contacting them in regards to your application Name* First Last Gender:*Preferred pronouns: (optional)Have you been referred to this program by someone else in the Teen program?*YesNoIf so, who?*If you have changed your name since birth, please provide original name:School:*Grade*Please enter a number between 9-12Residential Address:* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Mailing Address (if different than your residential address): Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Home Phone:*Cell Phone:*Email:* Enter Email Confirm Email Birth Date:* How long have you lived in the Lower Mainland or Sea to Sky Region?*Status/Citizenship:*If you have lived in another country, where?When?Languages Spoken* English French Do you speak any other languages?*YesNoAdditional Languages Spoken*As part of your commitment to the Teen Mentoring Program, you will be required to participate in a youth leadership training component with other Teen Mentors. This training may be provided at the same site as your program or at a nearby alternate site determined by your Mentoring Coordinator. It is designed to provide you with further leadership skills and enhance your experience as a mentor. Are you able to participate in the youth leadership portion of the Teen Mentoring Program?*YesNoThe Mentoring Coordinator at your school will follow up with you at the interview Do you have a part-time job?*YesNoIf yes, Employer's Name:*Why do you want to volunteer?*Have you ever been involved with children as a volunteer (e.g. Boys & Girls Club, Scouts, camps, sports etc.)?*What are your leisure time interests and activities? (e.g. clubs, sports, hobbies, special interests)* VOLUNTEER PERMISSION AND RELEASE AGREEMENT TO: [BIG BROTHERS OF GREATER VANCOUVER] (THE “AGENCY”) The Agency and Big Brothers Big Sisters Canada (“BBBSC”) are separate entities and this Agreement is between me and the Agency. 1. By applying to volunteer with the Agency (“Volunteer Application”) and signing this Agreement, I acknowledge, understand and accept that: (a) I am a legal resident of Canada and have reached the age of majority in the province or territory in which I reside. I acknowledge and agree that if I have not reached the age of majority of the province or territory in which I reside, my parent or legal guardian will also need to sign this Agreement in order for my Volunteer Application to be considered; (b) There is no obligation on the Agency to accept my Volunteer Application or assign me as a volunteer into a mentoring program (a “Mentoring Program”) and the Agency may terminate my involvement in a Mentoring Program in its sole discretion and without reason; (c) If I am accepted as a volunteer, my involvement in a Mentoring Program is not intended to create and shall not be construed as creating either an employee–employer relationship or a contract for services that would allow me to receive a salary, compensation, payment or any benefits, monetary or otherwise; and (d) If I am accepted into a Mentoring Program, I understand that I will be required to enter into a confidentiality agreement with the Agency, and I agree to abide by the volunteer position description(s) and code(s) of conduct established by the Agency, including any applicable guidelines, Standards and policies. 2. Assumption of Risk, Release and Reimbursement: I acknowledge, understand and accept that: (a) I am responsible for all risks associated with my involvement in a Mentoring Program including, without limitation, the risk of bodily or psychological harm or injury. (b) Subject to local laws, I agree not to sue the Agency, BBBSC and/or any of their member agencies in respect of any such injury or claim resulting from my participation in a Mentoring Program, my Volunteer Application, the acceptance or denial of my Volunteer Application, the Alumni Program and/or my association with the Agency or BBBSC. (c) I understand that I am fully responsible for any damage to my personal vehicle and/or property during my volunteer involvement in a Mentoring Program and that neither BBBSC nor the Agency insures personal vehicles or property belonging to its volunteers; (d) I agree to reimburse the Agency and/or BBBSC and/or any of their member agencies for any damages or losses of any kind (including but not limited to the injury of any other person and/or damage to or loss of property) that may arise in connection with my gross negligence, wilful misconduct, or failure to act in accordance with published BBSC policies and guidelines and relating to or arising in connection with my participation in a Mentoring Program or my association with the Agency or BBBSC, including payment of any and all legal expenses of the Agency, BBBSC and/or any of their member agencies. 3. Background Check. I understand that my acceptance into the Mentoring Program will be conditional on my successful completion of a background check, which may include contacting the references included in my Volunteer Application and/or a criminal record check, for the purposes of confirming my suitability for the Mentoring Program. I agree to provide all necessary consents for such background checks. 4. Privacy Notice. The personal information provided by me or otherwise collected by the Agency in connection with my application will be used by the Agency for the purpose of evaluating and considering my Volunteer Application and, if accepted into a Mentoring Program, for the purpose of administering the Mentoring Program. This information may include my name, phone number, mailing address, date of birth, results of background check, and driver’s license and auto insurance information. My personal information will be maintained by the Agency on a confidential basis and will only be disclosed to the parent(s) and/or guardian(s) of a child with whom the Agency may consider “matching” me in a Mentoring Program, to representatives of a school or institution in connection with my participation in a site-based Mentoring Program, to the BBBSC as required for the purposes of accreditation reviews or legal proceedings and as otherwise required or permitted by law. In the event the Agency ceases operations, any and all information about me held by the Agency will be provided to BBBSC, another BBBSC agency selected by BBBSC, or both and will be used for the purposes set out above. In the event where it is deemed necessary, any and all information about me held by the agency will be provided to BBBSC, another BBBSC agency selected by BBBSC, or both and will be used for the purposes set out above. No information will be provided to persons or organizations outside of Big Brothers Big Sisters of Canada, and its agencies, about parents, children or volunteers without their express prior written consent except where required by law. 5. Other Terms of this Agreement. (a) In entering into this Agreement, I am not relying on any oral or written representations other than as set forth in this Agreement. (b) This Agreement shall be governed by and construed pursuant to the laws of the Province or Territory in which the Agency is located. (c) In the event that any provision or term of this Agreement is held to be invalid, illegal or unenforceable, the remaining provisions of this Agreement shall remain in full force and effect. Please check if you have read, understand, and accept the above Agreement* IMPORTANT: I acknowledge that I have read the terms of this Agreement, have been given an opportunity to obtain independent legal advice, and understand that it represents a waiver of certain legal rights, including the right to sue. I further agree that such limits are reasonable and sign this Agreement freely, voluntarily and without duress. If you do not agree with item #6 Media Consent, please check here: I do NOT agree to Media Consent #6 Media Consent. Any photographs or video productions taken of volunteers by agency staff at recreational events or match outings, or otherwise authorized by the Executive Director or Board of Directors, may be used by the agency for purposes of promotional material including brochures posters, newsletters, media information, advertisements, audio-visual productions and web pages, such as the Agency website and social media. Photographs or video productions may also be shared with community and school partners and Big Brothers Big Sisters of Canada for program promotion. ReferencesPlease provide two references (one from school, and one personal) that know you well and are 19 years of age or older. Your personal reference must have known you for at least two years. We will contact them via the email address you provide as soon as we receive your guardian/parent consent form. If your personal reference doesn't have an email address, please contact your Mentoring Coordinator. Please make sure that you have notified your references that our agency will be contacting them in regards to your application.School ReferenceA school reference can be a teacher, counsellor, vice-principal or principal at your current school. If you have not attended your current school for at least one semester or term, you can use a reference from your previous school.Reference Name (Full Name)*School Name:*Position*Email:* Enter Email Confirm Email This person is 19 years or older and this person knows me well.*YesNoThis reference may not be accepted. Please contact someone else who is 19 years or older and knows you well at your current/previous school to be your school reference. If you need any clarification, please contact your Mentoring Coordinator. Personal ReferenceA personal reference refers to anyone other than a family member who knows you well and on a personal level. They could be your coach, colleague, religious leader, or family friend but may not be related to you.Reference Name (Full Name)*Relationship:*Email:* Enter Email Confirm Email Phone*This person is 19 years or older and has known you for at least two years*YesNoThis reference may not be accepted. Please contact someone else who is 19 years or older and has known you well for over two years, to be your personal reference. If you need any clarification, please contact your Mentoring Coordinator. Emergency Contact InformationPlease provide information for a family member or close friend over 19 years old we may contact in the event of an emergency. Full Name*Relationship:*Main phone number #:*Alternate phone number #: Consent from your parent/guardianPlease enter your parent/guardian's email address. They will receive our Volunteer Permission and Release Agreement and be asked to read it over with you, sign it and email it back to us within 24 hours of receipt in order to complete your application. You will sign the same form in person at your interview time. Parent/Guardian full name*Parent/Guardian's email address* Enter Email Confirm Email Relationship*
