Trial Outing – Caregiver Acknowledgement Form

This acknowledgement form is intended to confirm informed parental/caregiver consent for a trial outing between a prospective Mentor and and their child (i.e. the Mentee).

Trial outings are in-person meetings that occur after an initial Meet and Greet meeting is facilitated by a BBBSPY staff, and prior to a match being made official.

The purpose of the trial outing is to provide an opportunity for the prospective Mentor and Mentee to interact in a low-risk setting to assess compatibility and comfort.

This form ensures that parents/caregivers understand the expectations, boundaries, and supervision requirements associated with the trial outing process, and agree to the conditions outlined below.

Trial outings are not a mandatory step in the matching process. If you would prefer to skip this step, and move right to an official match meeting, please let your Caseworker know.

This field is for validation purposes and should be left unchanged.
Please enter your name(Required)
Please enter the name of your child(Required)
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Please select your primary Caseworker(Required)
Please review each of the important safety and participation requirements below before signing this form. If you have any questions or require clarification, please contact your Caseworker prior to confirming your consent.
I understand that BBBSPY STAFF WILL NOT BE PRESENT and are therefore not responsible for the safety of my child during this outing.(Required)
I understand that this is a trial outing only, intended to assess compatibility, and will last approximately 1 to 1.5 hours.(Required)
As my child's guardian, I am solely responsible for their oversight during this outing.(Required)
I am responsible for transporting my child to and from the outing location.(Required)
I will remain in close proximity while my child and the prospective Mentor engage in the activity. I will not participate in the activity, instead, I will passively observe, unless my involvement becomes required for safety reasons.(Required)
If I need to cancel or reschedule the outing, I will notify the Mentor as soon as possible and inform my Caseworker.(Required)
My child and I will inform the Caseworker of our interest in purusing an official match with the prospective Mentor within 1 week of the outing.(Required)
My child and I will not have any contact with the prospective Mentor outside of this outing unless and until a match is formally confirmed by the agency.(Required)
If my family and the prospective Mentor agree to proceed, my child and I will attend another meeting (the Match Meeting), facilitated by a Caseworker, to formalize the match and review expectations and guidelines.(Required)
I understand that only after this subsequent Match Meeting is completed, and I have been notified by the assigned Caseworker, will my child and their new Mentor be able to officially begin their match and arrange their meeting schedule.(Required)
Clear Signature
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