Trial Outing - Mentor Acknowledgement Form

This acknowledgement form is intended to confirm informed voluntary consent for a trial outing between a prospective Mentor and a prospective Mentee. Trial outings are in-person meetings that occur after an initial Meet & Greet facilitated by 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, comfort, and relationship potential. This form ensures that prospective Mentors 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 directly 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 the child you're meeting(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.(Required)
I understand that this is a trial outing only, intended to assess compatibility, and will last approximately 1 to 1.5 hours.(Required)
I am not permitted to transport the youth to or from the outing location.(Required)
I understand the parent/caregiver must remain in close proximity while I meet with my prospective Mentee. I also understand that the parent/caregiver will be a passive observer and should not be actively participating in the trial outing unless it becomes necessary for safety reasons.(Required)
If I need to cancel or reschedule the outing, I will notify my Caseworker as soon as possible.(Required)
I will inform the Caseworker of my interest in pursuing an official match with the prospective Mentee within 3 days.(Required)
I will not have any contact with the prospective Mentee outside of this outing unless and until a match is formally confirmed by the agency.(Required)
If the family and I both agree to proceed, 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 new Mentee and I be able to officially begin our match and arrange our meeting schedule.(Required)
Clear Signature
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