Mentoring with Math - Child Application Form - Big Brothers of Greater Vancouver

Mentoring with Math - Child Application Form

If you are interested in registering a child for the Mentoring with Math program, please fill out the following form. This application may be filled out by a parent, guardian, teacher, or school staff however the child waiver that is e-mailed to the parent/guardian e-mail provided must be signed by a parent or guardian. This waiver must be returned to Big Brothers of Greater Vancouver staff prior to the student participating in our programs. During the COVID-19 pandemic, an additional participatory waiver must also be signed. These waivers will be sent to the e-mail address provided.

Step 1 of 3

What day would you like to enroll your child in?*
Student Name*
First Last
Birthdate*
MM slash DD slash YYYY
Gender identity of the child*
Parent/Guardian's full name*
Relationship to the child?*
Address*
Street Address Address Line 2 City Province Postal Code
Email Address*
Enter Email Confirm Email
Home Phone*
Cell Phone*
OPTIONAL - Work Phone
Emergency Contact
Please ensure this person is someone other than the parent/guardian, and they must have a phone number that is different from the parent/guardian.
Emergency Contact's Full Name*
Address*
Street Address Address Line 2 City Province Postal Code
Relationship to Child*
Home Phone*
Cell Phone*
What school is your child enrolled in?*
What grade is your child currently in?*
What is your child’s grade level in math?**
This program is intended to support children struggling with math concepts at or below their grade level. How would your child benefit from the Math & Mentoring Program?*
Besides math, are there other challenges your child faces?*
We provide a small healthy snack to children in our after school programs. Does your child have any specific medical conditions, dietary restrictions, allergies or other concerns we should know about? Please describe*
Where did you hear about the program?*
The following optional information is asked for statistical purposes and for grant/funding support. The questions and responses do not indicate or affect participation requirements.
OPTIONAL - What ethnicity is your child?
OPTIONAL - Was your child born in Canada?
If not, how long as your child lived in Canada?
Languages Spoken*
Is there anything else you would like to share with us or that may be important for us to know?

Save and Continue Later

Authorized pick-up information - please choose one of the following:*
AUTHORIZED PICK-UP FORM
I, (parent/guardian), give permission to the following individuals to pick up my child from the Big Brothers of Greater Vancouver mentoring program. I have informed these individuals of the pick-up policy (see next page) and that they must present government-issued photo ID in order for my child to be released. Your children will not be allowed to leave the site with anyone other than those listed below. You can remove or add people to this list at any time by contacting your Mentoring Coordinator and signing an updated Authorized Pick-Up Form.
Please check if you have read, understand, and accept the above Agreement*
- Yes
Authorized pick-up person #1*
First Last
Relationship to Child*
Home Phone*
Cell Phone*
Authorized pick-up person # 2
First Last
Relationship to Child
Home Phone
Cell Phone

Save and Continue Later

For more information regarding this program, please contact Danielle Olson, Site-Based Lead at danielle.olson@bigbrothersbigsisters.ca, or via phone at 604-802-8839.

Mentoring with Math – Child Application Form

Mentoring with Math - Child Application Form

Step 1 of 3

Emergency Contact

AUTHORIZED PICK-UP FORM

ABSENT CHILD POLICY

PICK-UP POLICY

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