This form is to be completed by the parent/guardian of a child participating in the In-School Mentoring Program at one of our partner schools.
  • Please provide the name of your child's school.
  • Meeting through COVID-19

    We prefer that children meet weekly with their mentors for the duration of the school year. If your child's class or school has to shut down because of COVID-19, it might be possible to arrange for your child to keep meeting with their mentor in some other way. The mentor and child are not allowed to meet face-to-face unless they are on school property and the school is open. However, they could stay connected in other ways.
  • Yes, I want my child and their mentor to stay connected if the cannot meet at the school. My child to meet with their mentor in the following ways:
  • Are you willing/able to provide proof that your child has received their COVID-19 vaccine?
  • Would you allow your child to meet with a mentor who has not received their COVID-19 vaccine?

    This form must be signed by the child's parent or legal guardian.
  • I, the parent/guardian of the child named above, am requesting service from Big Brothers Big Sisters for my child. I give the agency consent to assign a Mentor to my child. I am aware of and understand the risks, dangers, and hazards associated with the above service and agree such service is suitable for my child.
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  • Although parents/guardians do not have to be involved in any particular way, the following options are available:
  • Parent/Guardian Photo/Media Consent

    From time to time, the following sorts of materials may be created in connection to school-based mentoring programs:
  • I, the parent/guardian of the child named above, completed this Parent/Guardian Photo/Media Consent form and I acknowledge that it is the parent/guardian’s responsibility to notify Big Brothers Big Sisters of Victoria if the status of this consent changes
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  • Covid-19

  • By entering your name you are confirming you agree to the above terms and conditions. (If the Participant is a minor, this form is to be signed by the Participant’s parent or guardian) If I am signing on behalf a minor Participant, I represent that I have legal capacity and authorization to act on behalf of the Participant. By entering your name on behalf of the Participant, you are confirming they agree to the above terms and conditions.
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  • By entering your name you are confirming you witnessed the Participant's Parent or Legal Guardian sign the consent form. Witness needs to be over 19 years of age.
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