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Enrollment Application Form - Big Brothers Big Sisters of Waterloo Region
  • About Us
    • Contact Us
    • Join the Team
    • Our Board
    • Annual General Reports
    • Our Partners
      • Best Friends of BBBSWR
  • What We Do
    • Our Programs
    • Stories
  • Get Involved
    • Become a Volunteer
    • Enroll a Young Person
    • Ways to Give
  • Events
    • Bowl For Kids’ Sake
    • Gourmet Dinner
    • KingstrEATery
    • JDG Swing Big Golf Classic
    • Taps & Apps
    • Wine Survivor
    • BBBS Month
    • Host an Event
  • Littles and Bigs
    • Activities
    • Community Resources
    • Mental Health Resources
    • Current Opportunities
    • Discount List
    • Scholarship Awards
Donate Volunteer

Enrollment Application Form

Enroll a Young Person

"*" indicates required fields

Step 1 of 6

16%
Program of Interest*
Please select all that apply.

Child's Information

Legal Name*
MM slash DD slash YYYY
Must be between 6 and 16 years of age.
Please enter a number from 1 to 12.
Languages Spoken*
Previous Involvement*
Has your child been previously involved with any Big Brothers Big Sisters agency in Canada?

Child's Medical Information

Medical Notes*
Does the child have any dietary restrictions, allergies, or any other medical notes that would affect participation in programming?
Please describe medical notes stated above.
Medical Authorization*
I, hereby, give permission to hospital and/or clinic staff to administer all reasonable and necessary medical care, in case of injury or illness to my child, while in the care of his/her Big Brother/Big Sister, in the event that I cannot be reached.

Primary Caregiver (With Legal Custody) Information

Name*
Please include Ext. #
Address*

Other Caregiver Information

Name
Address
Is the non-residential parent aware of your application with this agency?
Would the non-residential parent be supportive of this application?

Custody and Access Information

Sole, Visitation Rights, Joint, Etc.
Custody Issues*
Are there any ongoing custody or access issues?
Please describe the custody or access issues indicated above.

Emergency Contact Information

In the case of an emergency BBBSWR would always contact a guardian first, please list someone as a secondary contact, other than the registering guardian.
Name*
Others Living in the Home
First Name
Last Name
Relationship
Age
 
Please list all adults and other children living in your household, their relationship to the child, and their age (if under 18).

Child's Information

Does your child want a Mentor and to be involved in our programming?*
If applying for the Big Brother or Big Sister program, would your child also be interested in participating in our Big Bunch programming?*
Please read the Big Brothers/Big Sisters Consent Form by clicking on the icon below. Big Brother/Big Sister Consent Form
I have read and agree to the above Big Bunch informed consent form.*
Please read the Big Brothers/Big Sisters Consent Form by clicking on the icon below. Big Brother/Big Sister Consent Form
I have read and agree to the above Big Brothers/Big Sisters Program informed consent form.*
Please read the Big Brothers/Big Sisters Consent Form by clicking on the icon below. Big Brother/Big Sister Consent Form
I have read and agree to the above consent and waiver form.*
Please read the Big Brothers/Big Sisters Media Consent Form by clicking on the icon below. Big Brother/Big Sister Consent Form
I have read and agree to the above media consent form.*
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 BBBWR. 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.*
Parent/Guardian Name*
MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.
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To Reach Us
Big Brothers Big Sisters of Waterloo Region
101-135 George Street North Cambridge ON Canada N1S 5C3
Email: info@bbbswr.org Telephone: 5197450180 Contact us Monday: 9:00 AM - 4:30 PM Tuesday: 9:00 AM - 4:30 PM Wednesday: 9:00 AM - 4:30 PM Thursday: 9:00 AM - 4:30 PM Friday: 9:00 AM - 4:30 PM
Copyrights

© 2025, Big Brothers Big Sisters of Waterloo Region

Charitable Business Number: 131877177RR0001

We recognize the importance of language, and the impact of inclusivity and identity erasure. We acknowledge how our organizational name reinforces the gender binary and fails to honour Trans, non-binary and gender diverse identities. We welcome Mentors and Mentees who are 2SLGBTQ+.  

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