Volunteer Application Form for Mentors

Volunteer Application for Mentors - All programs

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About You

Big Brothers Big Sisters of Victoria Capital Region is committed to sustaining an environment where representation matters, diversity is celebrated and people of every race, religion, culture, gender and sexual orientation are welcomed. We acknowledge and honour the diversity of people, cultures, traditions and experiences, and we recognize and uphold the right of all individuals to respect, dignity, fairness, caring, equality, self-esteem and inclusion.

Your Name:*

First, Middle, Last

Previous Name(s):

First, Middle, Last

Mentoring Program Preference:

In which program would you like to volunteer first?

Mentoring Format:

In what ways are you willing to connect with your mentee each week?

Contact Details

Phone Number:*

Second Phone Number (if applicable):

Email Address:*

I live/attend school:*

in the Comox Valley

on Salt Spring Island

in Sooke

at Spectrum Community School

in Greater Victoria (between the West Shore and Sidney)

Home Address:*

Street Address City Province Postal Code

Demographics

Your Gender:*

Your Gender:

Please share your gender identity with us (e.g. male, female, non-binary, transgender, gender fluid, etc.). Knowing this can help us place you with someone who may have a similar experience.

Your Pronouns

What pronouns do you use? Let us know one or all that you prefer when introducing yourself (i.e. she/her, he/him, they/them.

Your Date of Birth:*

Volunteers must be aged 14 or older to become a mentor in our programs.

Language(s) spoken:

Cultural Background:

This section is voluntary and used for statistical puposes only. If you are comfortable sharing with us, please select the option or options which best represent your racial identity.

contact with Big brothers big sisters

Newsletters

Big Brothers Big Sisters emails out regular newsletters and e-blasts that provide information about agency events and activities. We will not sell or share your information. You may opt out of receiving our newsletters at any time in the future.

I want to receive the newsletter and e-blasts

I do not want to receive the newsletter and e-blasts

Source of Inquiry:

How did you find out about the mentoring programs at Big Brothers Big Sisters of Victoria?

more about you

Relationship Status (for Community Mentors only):

Educational Background:

Please tell us the highest level of education you have completed.

Current School Details:

If you are enrolled at a secondary or post-secondary institution, please provide the name of your school and your area of speciality (i.e history, grade 10, etc.)

Employment Information:

Please tell us your current employment status.

Current Employer's Details:

If you are currently employed, please provide your company's name, your job title, and the length of time you have been with this company.

Previous Involvement with Big Brothers Big Sisters*

Have you ever applied to or been a volunteer with a Big Brothers Big Sisters agency in the past?

Previous Involvement with Other Agencies

Have you ever volunteered for another agency to support children or vulnerable people?

Why do you want to be a mentor with Big Brothers Big Sisters?

Reference Section

Please provide contact details for each reference type (Min. 3 required). The person who provides the reference must be aged 19 or older. Please give us their email address. If this is not possible, ensure their phone number is included. Let your references know that we will send them a brief questionnaire about you, They can complete it by e-mail, telephone or through an on-line survey platform. Please ask them to follow up with us as quickly as possible.

Personal Reference*

A friend, neighbour or colleague. Someone who has known you for two years or more.

Their Name: Connection to you and length of relationship: Their Phone #: Their Email:

Family Reference*

If you are married or living common-law, please provide your partner's details. If you are not married or living common-law, please provide details for a family member (parent/sibling/cousin, etc.)

Their Name: Connection to you and length of relationship: Their Phone #: Their Email:

Employment Reference or Teacher Reference*

For teen mentors only: A teacher or school counsellor. For adult mentors only: A supervisor, team-lead, or manager in a current or past employment role.

Their Name and Company/School Name: Connection to you and length of relationship: Their Phone #: Their Email:

Vulnerable Sector Reference

You must provide a Vulnerable Sector Reference if, within the last 5 years, you have worked and/or volunteered with a person and/or organization responsible for the well-being of children under the age of 18 (this includes baby-sitting for children other than your own siblings) or vulnerable persons who, because of their age, disability, or other circumstances, are at greater risk than the general population of being harmed by a person in a position of authority or trust relative to them.

Their Name and Company/Organization Name: Connection to you and length of relationship: Their Phone #: Their Email:

Activities List - Fun Things to Do Together

Please select the activities, events and/or places you enjoy or would like to try with your mentee.

Outdoor/sports activities:

Creative/playful activities:*

Places and Events:

What other activities would you like to try with your mentee?

Availability:

When can you meet with a mentee? Please check all that apply. We understand that students may have to adjust their schedules for each semester.

Please check the characteristics that describe you:*

Highly Active

Friendly

Outgoing

Helpful

Quiet

Shy

Withdrawn

Other

signature section

By entering your name below, you are acknowledging that:*

The information I have provided is true to the best of my knowledge.

First and Last Name:

Date of Application:

volunteer permission and release agreement

To: BIg Brothers Big Sisters of Victoria and Area (The Agency)*

The Agency and Big Brothers Big Sisters Canada (“BBBSC”) are separate entities and this Agreement is between me and the Agency.

1. By applying to volunteer with the Agency (“Volunteer Application”) and signing this Agreement, I acknowledge, understand and accept that:
(a) I am a legal resident of Canada and have reached the age of majority in the province or territory in which I reside. I acknowledge and agree that if I have not reached the age of majority of the province or territory in which I reside, my parent or legal guardian will also need to sign this Agreement in order for my Volunteer Application to be considered;
(b) There is no obligation on the Agency to accept my Volunteer Application or assign me as a volunteer into a mentoring program (a “Mentoring Program”) and the Agency may terminate my involvement in a Mentoring Program in its sole discretion and without reason;
(c) If I am accepted as a volunteer, my involvement in a Mentoring Program is not intended to create and shall not be construed as creating either an employee–employer relationship or a contract for services that would allow me to receive a salary, compensation, payment or any benefits, monetary or otherwise; and
(d) If I am accepted into a Mentoring Program, I understand that I will be required to enter into a confidentiality agreement with the Agency, and I agree to abide by the volunteer position description(s) and code(s) of conduct established by the Agency, including any applicable guidelines, Standards and policies.

2. Assumption of Risk, Release and Reimbursement:
I acknowledge, understand and accept that:
(a) I am responsible for all risks associated with my involvement in a Mentoring Program including, without limitation, the risk of bodily or psychological harm or injury.
(b) Subject to local laws, I agree not to sue the Agency, BBBSC and/or any of their member agencies in respect of any such injury or claim resulting from my participation in a Mentoring Program, my Volunteer Application, the acceptance or denial of my Volunteer Application, the Alumni Program and/or my association with the Agency or BBBSC.
(c) I understand that I am fully responsible for any damage to my personal vehicle and/or property during my volunteer involvement in a Mentoring Program and that neither BBBSC nor the Agency insures personal vehicles or property belonging to its volunteers;
(d) I agree to reimburse the Agency and/or BBBSC and/or any of their member agencies for any damages or losses of any kind (including but not limited to the injury of any other person and/or damage to or loss of property) that may arise in connection with my gross negligence, wilful misconduct, or failure to act in accordance with published BBSC policies and guidelines and relating to or arising in connection with my participation in a Mentoring Program or my association with the Agency or BBBSC, including payment of any and all legal expenses of the Agency, BBBSC and/or any of their member agencies.

3. Background Check. I understand that my acceptance into the Mentoring Program will be conditional on my successful completion of a background check, which may include contacting the references included in my Volunteer Application, receiving volunteer information from other BBBSC agencies, and/or a criminal record check, for the purposes of confirming my suitability for the Mentoring Program. I agree to provide all necessary consents for such background checks.

4. Privacy Notice. The personal information provided by me or otherwise collected by the Agency in connection with my application will be used by the Agency for the purpose of evaluating and considering my Volunteer Application and, if accepted into a Mentoring Program, for the purpose of administering the Mentoring Program. This information may include my name, phone number, mailing address, date of birth, results of background check, and driver’s license and auto insurance information. My personal information will be maintained by the Agency on a confidential basis and will only be disclosed to the parent(s) and/or guardian(s) of a child with whom the Agency may consider “matching” me in a Mentoring Program, to representatives of a school or institution in connection with my participation in a site-based Mentoring Program, to the BBBSC as required for the purposes of accreditation reviews or legal proceedings and as otherwise required or permitted by law. In the event the Agency ceases operations, any and all information about me held by the Agency will be provided to BBBSC, another BBBSC agency selected by BBBSC, or both and will be used for the purposes set out above.

In the event where it is deemed necessary, any and all information about me held by the agency will be provided to BBBSC, another BBBSC agency selected by BBBSC, or both and will be used for the purposes set out above. No information will be provided to persons or organizations outside of Big Brothers Big Sisters of Canada, and its agencies, about parents, children or volunteers without their express prior written consent except where required by law.

5. Other Terms of this Agreement.
(a) In entering into this Agreement, I am not relying on any oral or written representations other than as set forth in this Agreement.
(b) This Agreement shall be governed by and construed pursuant to the laws of the Province or Territory in which the Agency is located.
(c) In the event that any provision or term of this Agreement is held to be invalid, illegal or unenforceable, the remaining provisions of this Agreement shall remain in full force and effect.

6. Media Consent. Any photographs or video productions taken of volunteers by agency staff at recreational events or match outings, or otherwise authorized by the Executive Director or Board of Directors, may be used by the agency for purposes of promotional material including brochures posters, newsletters, media information, advertisements, audio-visual productions and web pages, such as the Agency website and social media. Photographs or video productions may also be shared with community and school partners and Big Brothers Big Sisters of Canada for program promotion.

I acknowledge that I have read the terms of this Agreement, have been given an opportunity to obtain independent legal advice, and understand that it represents a waiver of certain of my legal rights, including my right to sue (subject to local laws). I further agree that such limits are reasonable and sign this Agreement freely, voluntarily and without duress.

Signature of Applicant:*

By entering my name below, I acknowledge that I agree to the above terms and conditions.

First and Last Name:

Date of Permission and Release Agreement:*

Signature of Parent/Guardian (if required):

By entering my name below, I acknowledge that I agree to the above terms and conditions.

First and Last Name:

Date of Signature by Parent/Guardian:

Code of Conduct

Mentor Code of Conduct*

Big Brothers Big Sisters provides children and youth with safe, quality mentoring relationships with volunteer mentors. Serving as role models, Big Brothers Big Sisters mentors teach by example the importance of giving and giving back, of staying in school, and of having respect for family, peers and community.
As a mentor, you share with your mentee, their parents/guardians, the Big Brother Big Sister Agency, and (in certain programs) partnering site-based staff, a commitment to fostering a safe, enjoyable, meaningful, and healthy mentoring relationship by observing the following code of conduct:
 Mentors agree to conduct themselves in a manner consistent with their position as a positive role model to a child/youth, and as a representative of the Agency.
 Mentors will follow Agency policy and guidelines around the safety of their mentee as outlined in the Pre-Match Training Program.
 Mentors agree to respect the privacy and dignity of their mentee and family by not divulging confidential information without consent, except where required by law as in the case of suspected child abuse.
 Mentors agree to honour the commitment of spending time together on a regular basis, yet agree to limit their involvement in their mentee’s life to what is deemed appropriate by the Agency. Mentors are seen as an influence, not a dominant factor, in their mentee’s life.
 Mentors will establish boundaries with both their mentee and their mentee’s parent/guardian. Mentors understand it is not their role to provide support to the parent/guardian, but will respect the family’s boundaries and approach.
 The mentor-mentee relationship is based on mutual respect. Mentors agree to treat the Mentee and their family in a respectful way at all times.
 Mentors agree to allow their mentee to develop their friendship at their own pace.
 Mentors agree to participate in regular support meetings to discuss the match relationship and to commit to a mandatory match monitoring schedule to ensure the match is safe and healthy; to ensure their mentee derives the most benefit possible from the mentoring friendship; and to ensure both mentee and mentor are feeling valued and supported in the match.
 Mentors agree to notify the agency of any changes of circumstances (living situation, change of address, phone number, etc.)
 Mentors agree to connect with program staff to formally close the match. Spending time to close the match in a positive way is essential and is empowering for the mentee. Mentors understand it is imperative, for the well-being of the mentee, to take the time to work with program staff on a positive closure that celebrates the accomplishments of the match relationship.

I agree to abide by the Mentor Code of Conduct

Signature of Applicant:*

By entering my name below, I acknowledge that I agree to the above terms and conditions.

First and Last Name:

Date of Mentor Code of Conduct Agreement:*

CONFIDENTIALITY

CONFIDENTIALITY POLICY*

All staff and volunteers of Big Brothers Big Sisters of Victoria and Area are required to abide by this Confidentiality Policy. Any breach of this policy will be considered grounds for termination.

Agency Service Delivery Staff will explain the confidential nature of our service to the volunteer, child and parent/guardian as early as possible in the orientation and/or screening process. At all times thereafter Service Delivery Staff will ensure the privacy of case information.

Information contained in the Casework files will not be disclosed by the Agency to any person without written approval of said person except in the following cases:

 where the safety of a child depends upon divulging this information. This could include suspicion of neglect or abuse of a child. The proper authorities will be informed when necessary. This could result in the disclosure of confidential information without written consent from the person to Brothers Big Sisters of Canada’s insurers and or legal counsel, as may be appropriate in connection with any legal proceeding or inquiry;
 when subpoenaed by the courts;
 where required by law;
 during periodic agency accreditation reviews case records, including relevant personal information will be shared to authorized representatives of Big Brothers Big Sisters of Canada.

In the event that confidential information is requested to support a custody or access application, or for any court matter other than a “child protection” case, the agency will only release the information if required to do so by a Judge’s Order.

No staff member or volunteer shall use confidential information from the agency to advance any personal interest, financial or otherwise.

In accordance with Big Brothers Big Sisters of Canada’s National Standards:
 No information will be provided to persons or organizations outside of Big Brothers Big Sisters of Canada, and its agents, about parents, children or volunteers without their express prior written consent except where required by law.
 All information and records, including electronic records, shall be kept secure (for example, in a filing cabinet, desk, etc. under lock and key, password protected, etc.) and confidential at all times.

Case records will be accessible only to the Caseworker, Executive Director, Casework Supervisor, and in appropriate situations, other Caseworkers.

I understand the agency’s policy around confidentiality and agree to abide by those rules

Signature of Applicant:*

By entering my name below, I acknowledge that I agree to the above terms and conditions.

First and Last Name:

Date Confidentiality Policy Agreement Signed:*

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