Thank you for your interest in Bigs on Campus. Once your submission has been reviewed by our team, you will receive an email confirmation with more details about the program.


Child's Name*
MM slash DD slash YYYY
This response is voluntary and will be used for statistical purposes only.
Child's Birth Place
This response is voluntary and will be used for statistical purposes only.

Parent/Guardian's Name*
Relation to Child*

I am the parent/guardian of the child for whom I am making this application.*
How did you hear about this program?*

Family Address*


Alternate Contact Name*
Please provide an alternate contact to call in case of emergency.


Does your child have any medical or behavioral needs that we should be aware of?*
We realize that this information can be of a sensitive nature and it will be treated with confidence and respect.
Does your child have any food allergies or restrictions?*
Ex. religious or cultural views, stressors, other existing issues?


Please select the appropriate program location.*
Please note that guardians are responsible for pick-up and drop off.

Media Consent

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

Informed Consent

I hereby give permission to Big Brothers Big Sisters of Peel (BBBSP)*
I hereby give permission to Big Brothers Big Sisters of Peel (BBBSP) 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), 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 BBBSP, 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 BBBSP, with the group facilitator so that my child’s needs may be best met. I understand that this application is the property of BBBSP. I also agree that my child will participate in the Pre- Match Training Program administered by BBBSP. I have read and understand this agreement. By checking YES, I acknowledge that I am the parent/guardian of the child for whom I am applying and that I 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 BBBSP. 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.

Parent/Guardian Signature