We realize that this information can be of a sensitive nature and it will be treated with confidence and respect.
Ex. religious or cultural views, stressors, other existing issues
I hereby consent to Big Brothers Big Sisters of Leeds and Grenville (BBBSLG), the use of any photographs, audio and/or video recordings of my child taken during the program as authorized by the BBBSLG. I give my permission for this media to be used by BBBSLG for purposes of promotional material including brochures, posters, newsletters, media information, advertisements, audio-visual productions and digital media, (such as the BBBSLG website and social media). Photographs or video productions may also be shared with community and school partners for program promotion.
I hereby give permission to Big Brothers Big Sisters of Leeds and Grenville (BBBSLG) to make available their service to my child. It is my understanding that the intention of the Agency is to offer my child an opportunity to participate in a group program lead by a responsible adult, (minimum 18 years old), I understand that all efforts will be made to select a responsible Mentor who will facilitate the group program. In consideration for this service and other valuable consideration provided to my child by BBBSLG, 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 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 further agree that information about my child may be shared, at the discretion of BBBSLG, with the group facilitator so that my child’s needs may be best met. I understand that this application is the property of BBBSLG. I also agree that my child will participate in the Pre- Match Training Program administered by BBBSLG. I understand that my child will be meeting in this group virtually on a pre-determined schedule, decided by Big Brothers Big Sisters of Leeds and Grenville. I understand it is the responsibility of the BBBSLG mentors and participants to ensure that these virtual sessions are conducted in a safe and respectful manner. I understand that Big Brothers Big Sisters of Leeds and Grenville cannot be held accountable for any technical errors with the streaming service used for the virtual after school program. I have read and understand this agreement. By checking YES, I acknowledge that I am the parent/guardian of the child for whom I am applying and that I hereby request Big Brothers Big Sisters service for my child. I give my child permission to participate in one or more group programs offered by BBBSLG. I am aware of and understand the risks, dangers and hazards associated with the above service and agree such service is suitable for my child