Thank you for your interest in Big Brothers Big Sisters of York mentoring programs. Please complete the Inquiry Package below to the best of your ability. We recognize that some of the questions may be sensitive in nature and want to assure you, your responses will be treated respectfully and remain strictly confidential.

Child's Name*
MM slash DD slash YYYY
Select the program(s) you are most interested in*
Parent/Guardian's Name*
Relation to Child*

Are you the legal guardian of this child?*
Please include specific needs/focus areas and what you hope your child will gain from this experience.
Has your child ever been identified with any special or additional emotional, social, cognitive or physical needs?*
i.e. mental health concerns, learning disabilities, cognitive impairments, behavioural/peer difficulties, etc.
i.e. diagnosis/suspected diagnosis, how your child's needs are currently being addressed, any medications your child may be taking, etc.
Is your child seeking assistance from any other social or community service?*
(i.e. child welfare, community agencies, therapists, school support staff, etc.)
i.e. name of agency, type of service received, etc.
Please select the most important factors for your child at this time. You are welcome to select any that apply*