GG Registration

Dear Parent/Guardian:

Big Brothers Big Sisters of Waterloo Region (BBBSWR) would like to invite your child to participate in our GG Healthy Bodies, Healthy Minds! group program. The GG Healthy Bodies, Healthy Minds! program is designed for youth who identify as female, transgender, or non-binary, ages 11-14 and provides them with information to help make informed choices about healthy, active living. The goal of the program is to help participants develop self-esteem, healthy eating habits and be physically active. Please let us now if your child requires transportation, we may be able to provide bus tickets.

Our volunteers are caring adults, with various skill sets and a range of experience working with children and youth. Volunteers are extensively screened, receive training regarding child safety, and are supported through consistent contact with Program Coordinators from BBBSWR.

The GG Healthy Bodies, Healthy Minds! Program strives to:

create appreciation for the benefits of an active, healthy lifestyle
build understanding of what constitutes healthy eating habits and the risks associated with eating disorders
promote the importance of positive mental activity, regular physical exercise and overall mental and physical well-being
Destigmatize youth mental health concerns, and promote healthy coping strategies
encourage awareness of core values, personal interests, strengths and attributes(/li>
support the development of leadership and life skills
offer guidance in establishing and maintaining friendships
allow participants to develop the means to effectively deal with societal and peer pressures
give participants the opportunity to practice healthy living behaviours

In order for your child to participate in this program please complete the following form in its entirety. Spaces fill up quickly, so please fill out your registration form as soon as possible. If you have any questions pertaining to the program, please do not hesitate to contact us the BBBSWR office at 519-745-0180 ext. 207.

Child's Information

Child's Legal Name(Required)

First Last

Child's Preferred Name

Gender

Pronouns

Date of Birth

Postal Code

Please list any allergies or medical concerns we should be aware of (please note that agency staff can not be held responsible for administering any medications to children.)

Parent/Guardian's Information

Parent/Guardian's Name(Required)

First Last

Phone Number(Required)

Email(Required)

Emergency Contact Information

Emergency Contact Name(Required)

First Last

Relationship to Child

Phone Number(Required)

Email(Required)

Pre-Match Training

All children who participate in BBBSWR programs must have Pre-Match Training. This training has three primary purposes, to: prepare match participants for their role in a healthy, successful mentoring relationship; illuminate safety issues and strategies; and, emphasize that resources and ongoing support will be available to all match participants.

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 the agency my consent to assign a Mentor to my child. 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.

I HAVE READ AND UNDERSTAND THIS AGREEMENT.(Required)

YES

Informed Consent Signed By:(Required)

First Last Email

Date signed On:(Required)