Child Enrollment Inquiry - Big Brothers Big Sisters of Chatham-Kent

Below is our eligibility checklist to ensure that your child and family meets the criteria for our services. Please check all that apply.*

My child is between the ages of 6-16.
My child is interested in being involved with Big Brothers Big Sisters. Children who are not interested are not eligible.
My child is able to communicate verbally and manage self-care independently.
My child is able to form a two-way relationship with a volunteer that is positive, healthy and respects boundaries.
My child does not have any behaviours that could potentially put themselves or a volunteer at risk of harm.
My child has a general understanding of personal boundaries and will be able to take part in a personal safety training prior to being matched.
My child demonstrates some sort of need for a role model or one-to-one time with an adult. (Lack of role models, social isolation, large family, high needs siblings, bullying at school, etc.)
I understand that if I do not have sole custody, consent from the other parent will be required.
I understand that it becomes more difficult to match children who register after the age of 13. As a result, my child may only receive group services.
I understand that this is a volunteer based service meant to be rewarding for both the child and volunteer. This is not a respite or child care program.
I understand that there is a wait-list that may exceed two years time. However, my child will still be invited to take part in group activities while they wait.
I understand that the Agency may request to contact any professionals involved with my child, including their school.
I understand that the Agency is under no obligation to provide my child with a mentor.

If you have any questions or concerns about any of these points, please continue your inquiry with a caseworker by calling 519-351-1582.

Child's First and Last Name*

Gender*

Age*

Parent/Guardian's First and Last Name*

Parent/Guardian's Relationship to the Child*

Address*

Address Unit # or P.O. Box City Province Postal Code

Phone*

Email*

Have you ever applied to a Big Brothers Big Sisters agency in the past? If so, where?*

Who referred you to Big Brothers Big Sisters?

How do you believe a Big Brother or Big Sister could help meet your child's needs?*

Is your family receiving any other supports? If so, from which agencies?*

Please include any other relevant information you believe we should know.

First and last name of the person filling out this form:*

What is your relationship to the child?*

If you are not the child's caregiver, please provide your contact email:

Name

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