Building BIG Leaders – Registration Form

BBBSPY’s Building BIG Leaders is a dynamic and empowering workshop series designed to transform high school students into confident and impactful teen mentors. Through a blend of interactive workshops and hands-on activities, this program focuses on giving youth the tools to grow as leaders while making a positive impact right away. This program is for any high school student who wants to make a difference and grow as a leader. Whether you’re already involved in school activities or just starting to explore your potential, Building BIG Leaders will give you the skills and confidence to lead, mentor, and inspire those around you.

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Youth's Name*
MM slash DD slash YYYY
Youth's Grade*
First and Last
Relation to Child*

Family Address*

Current needs & interests

Please select any of the topics below that your child would be interested in learning more about*
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Informed Consent

I hereby give permission to Big Brothers Big Sisters of Peel York 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 Peel York, 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 Peel York, 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 Peel York. I also agree that my child will participate in the Pre- Match Training Program administered by Big Brothers Big Sisters of Peel York.*

Media Consent

I hereby consent to Big Brothers Big Sisters of Peel York (BBBSPY), the use of any photographs, audio and/or video recordings of my child taken during the program as authorized by the BBBSPY President & CEO or Board of Directors. I give my permission for this media to be used by BBBSPY for purposes of promotional material including brochures, posters, newsletters, media information, advertisements, audio-visual productions and digital media, (such as the BBBSPY website and social media). Photographs or video productions may also be shared with community and school partners for program promotion.*
Clear Signature

OPTIONAL SECTION: STATISTICAL INFORMATION

Youth's Birth Place

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