Thank you for your interest in the Game On! program. 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.

How did you hear about this program?*
Parent/Guardian's Name*
Relation to Child*

I am the parent/guardian of the child for whom I am making this application*
Family Address*
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?

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.*

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