Informed Consent – Parent/Guardian – Big Bunch Program 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 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 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 of Waterloo Region. I also agree that my child will participate in the Pre- Match Training Program administered by Big Brothers Big Sisters of Waterloo Region.I HAVE READ AND UNDERSTAND THIS AGREEMENT. BY SIGNING THIS AGREEMENT, I ACKNOWLEDGE THAT: I, the parent/guardian of my child 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.Name of Parent/Guardian* First Last Email* Name of Child* First Last I have read, understand and completed the Informed Consent Form. By clicking YES I hereby confirm that the information provided is accurate, correct and complete to the best of my knowledge. I authorize Big Brothers Big Sisters of Waterloo Region to use the information I provided within their agency.* Yes No Date Signed* MM slash DD slash YYYY Facebook Twitter Google+ LinkedIn
