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Enrollment Application Form - Big Brothers Big Sisters of Waterloo Region
  • About Us
    • Contact Us
    • Join the Team
    • Our Board
    • 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
    • BBBS Month
    • Bowl for Kids Sake
    • Chefs’ Gourmet Dinner
    • JDG Swing Big Golf Classic
    • King StrEATery Food Truck Festival
    • Online Holiday Auction
    • Taps and Apps
  • Littles and Bigs
    • Activities
    • Community Resources
    • Current Opportunities
    • Discount List
Donate Volunteer

Enrollment Application Form

Enroll a Young Person

Step 1 of 6

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  • Please select all that apply.
  • Child's Information

  • Must be between 6 and 16 years of age.
  • Please enter a value between 1 and 12.
  • Add a new row Remove this row
  • Has your child been previously involved with any Big Brothers Big Sisters agency in Canada?
  • Child's Medical Information

  • 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.
  • 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

  • Please include Ext. #
  • Other Caregiver Information

  • Custody and Access Information

  • Sole, Visitation Rights, Joint, Etc.
  • 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.
  • First NameLast NameRelationshipAge 
    Add a new row Remove this row
    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

  • 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 form.
  • 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
302-30 Duke Street W Kitchener ON Canada N2H 3W5
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
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© 2019, Big Brothers Big Sisters of Waterloo Region

Charitable Business Number: 131877177RR0001

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