School-Based Mentoring Programs in York School Registration Form – York Region & Bradford SCHOOL INFORMATIONSchool Name:(Required) School Address(Required) Street Address Address Line 2 City Province Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Lunch Hour Start Time(Required) Hours : Minutes AM PM AM/PM Lunch Hour End Time(Required) Hours : Minutes AM PM AM/PM SCHOOL LIAISON INFORMATIONPlease provide the name and contact information for the school staff responsible for coordinating these programs along with BBBSPY staff. Primary School Liaison(Required) First Last Position/Title Primary School Liaison Email Address(Required) Secondary School Liaison First Last Position/Title Secondary School Liaison Email Address PROGRAM SELECTIONPlease select the program(s) you are interested in hosting at your school, and which timeframe(s) you would prefer. Unfortunately, we cannot guarantee Mentor availability at your preferred time, so please select any that apply. Go Girls! Healthy Bodies, Healthy MindsGo Girls! is a free group mentoring program designed to connect and empower female-identifying youth between 11-14 years old. This program promotes physical activity, balanced eating, self-confidence, and stress management. Go Girls! is typically delivered once a week during the lunch hour for 7 consecutive weeks. A private, open space such as the gym or library is needed to ensure the program runs as intended. *This program is open to all female-identifying individuals. This includes trans, cis-gender, non-binary, two-spirit or anyone else who feels they belong. If you have any questions, please reach out to the Director of Service Delivery & Partnerships, Katie Lowes. Fall (Oct-Dec) Winter (Jan-Mar) Spring (Apr-Jun) Select AllGame On! Eat Smart, Play Smart, Live SmartGame On! is a free group mentoring program designed to engage male-identifying youth between 11-14 years old. This program promotes physical activity, positive nutrition, stress management, and relationship skills. Game On! is typically delivered once a week during the lunch hour for 7 consecutive weeks. A private, open space such as the gym or library is needed to ensure the program runs as intended. *This program is open to all male-identifying individuals. This includes trans, cis-gender, non-binary, two-spirit or anyone else who feels they belong. If you have any questions, please reach out to the Director of Service Delivery & Partnerships, Katie Lowes. Fall (Oct-Dec) Winter (Jan-Mar) Spring (Apr-Jun) Select AllWellness WarriorsWellness Warriors is a free group mentoring program designed to engage youth in grades 3-8. This program promotes physical, social and mental wellness. Wellness Warriors is typically delivered once a week during the lunch hour for 7 consecutive weeks. A private, open space such as the gym or library is needed to ensure the program runs as intended. Fall (Oct-Dec) Winter (Jan-Mar) Spring (Apr-Jun) Select AllIn-School MentoringIn-School Mentoring is a free 1:1 program for youth in grades 1-8. Each child is matched with a uniquely-suited role model to talk to and share common interests with. The Mentor and Mentee spend time together on school property. In-School Mentoring is typically delivered during class time for an hour each week throughout the school year. Matches will require access to spaces around the school that are conducive to their chosen activities, such as an unused classroom, a quiet spot in the library, the school yard, etc. Yes, I am interested in this program for my school No, I am not currently interested in this program for my school Preferred Program SchedulePlease select the day(s) you are able to host programming at your school. Unfortunately, we cannot guarantee Mentor availability on your preferred day, so please select any that apply.Please select your preferred day(s) programming.(Required)Please note: Game On! Go Girls! and Wellness Warriors group programs are best facilitated in the gym where there is adequate space for all activities. Monday Tuesday Wednesday Thursday Friday Any day of the week can work Please use this space to indicate any specific scheduling requests.Thank you for taking the time to complete this registration form and for your interest in BBBSPY programming in your school. In order for any school-based program to be successful, we will require the full support of the School Liaison. This includes leading the promotion and recruitment of program participants and acting as an onsite resource for volunteer Mentors and agency Staff. The School Liaison will need to be on school property during the delivery of the program(s). BBBSPY Staff will be available to answer questions and provide any support needed during the set up of the program, and thereafter. EmailThis field is for validation purposes and should be left unchanged. Facebook Twitter Google+ LinkedIn