Roots Mentoring - Child Application Form - Big Brothers of Greater Vancouver

Roots - Child Application Form

If you are interested in registering a child for the Teen Mentoring or Roots program virtually this 2020-2021 school year, please fill out the following form. An electronic waiver will be sent to the Parent/Guardian upon submission, and 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.

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?*
Please list at least four of your child's interests and favourite activities to help us match your child to a Mentor who shares similar interests.*
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?

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Please connect with us if you have questions:

Danielle Olson

Site Based Program Lead

(604) 802-8839 or Danielle.Olson@bigbrothersbigisisters.ca

Roots Mentoring – Child Application Form

Roots - Child Application Form

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