GG/GO Parent/Guardian Package

Dear Caregiver:
Big Brothers Big Sisters of Waterloo Region (BBBSWR), in partnership with your child’s school, is pleased to inform you that your child has been invited to participate in the Go Girls!, Game On! or Mind and Motion 2.0 Program. These programs have been designed to provide students with information to help them make informed choices about healthy, active living and support them in dealing with the emotional, social, and cultural issues they may face. Each program meets on a weekly basis, at their school, over a 7 week period for approximately 90 minutes per week during the school day.

All Mentors are carefully screened and trained by BBBSWR staff. Please be aware that in the Go Girls!, Game On! and Mind and Motion 2.0 programs, there is a strict policy of no contact between the mentors and the children outside of their scheduled group sessions (including but not limited to social media, email or in-person meetings). Matches also do not have contact over the summer break or during other school holidays.

While the Go Girls! and Game On! programs were developed as gender-specific programs, BBBSWR is an inclusive organization that welcomes all individuals to participate in whichever group they feel most comfortable in. If you, or your child, have any questions, please feel free to contact the school or program staff.

In order for your child to participate in this program please sign and return the attached forms to the school. Once these forms are received by the school, your child will be added to a waiting list to be matched in a group. Please note that we cannot guarantee a group for your child as we are a volunteer based organization. If you have any questions pertaining to the program, please do not hesitate to phone your child’s school or Jenna Watson at the BBBSWR office at 519-745-0180 ext. 205.

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Step 1 of 2

Child's Legal Name*

Child's Name Last

Child's Preferred Name*

First

Gender

Preferred Pronouns

Date Of Birth*

Postal Code*

Postal Code

Child's School*

Parent/Guardian Information*

Parent/Guardian's Name

Phone Number*

Email*

Informed Consent

I hereby give permission to Big Brothers Big Sisters of Waterloo Region 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, however, where appropriate supervision takes place, the volunteer may be younger), 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 Big Brothers Big Sisters of Waterloo Region, 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 Big Brothers Big Sisters of Waterloo Region, with the group facilitator so that my child’s needs may be best met.

I understand that this application is the property of Big Brothers Big Sisters Waterloo Region. I also agree that my child will participate in the Pre- Match Training Program administered by Big Brothers Big Sisters Waterloo Region.

I HAVE READ AND UNDERSTAND THIS AGREEMENT. BY SIGNING THIS AGREEMENT, I ACKNOWLEDGE THAT:

I, the parent/guardian 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 Big Brothers Big Sisters of Waterloo Region. 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.*

Yes

Informed Consent Signed by*

Parent/Guardian Name

Date of Signature*

Phone

This field is for validation purposes and should be left unchanged.

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