ISM Parent/Guardian Renewal/Cancellation Form - Big Brothers Big Sisters of Victoria Capital Region

Your child was matched at their school with a school-based mentor from Big Brothers Big Sisters of Victoria Capital Region during the 2021-2022 school year. At this time, we believe that it will be possible for child and their mentor to continue meeting together for one hour/week during the 2022-2023 school year as well.

If you want your child to continue in the program, you do not need to do anything

I want changes to my child's participation in the program during the 2022-2023 school year:

I do not want my child to have a mentor this year, or
I do not want my child to have the same mentor this year

Parent/Guardian Name:*

First Last

My Child Lives in:*

Comox Valley
Salt Spring Island
Sooke
Greater Victoria

My Child Attends School at:*

Home Address:

Street Address City Province Postal Code

Phone:*

Email:

Name of Child:*

First Last

By entering my name below, I am acknowledging that:*

I, the parent/guardian of the child named above, am removing my permission for my child to be matched with a mentor through the In-School Mentoring Program at Big Brothers Big Sisters.

First Last

Signed on this date:*