File # _________________

Attach Picture Here

Volunteer Enrollment Form High School Bigs
Office Use Only:
Date Received ________ Interview _________ RTBM _________ Picture Reference Closed ________

Pg. 1/5
Volunteer Information Male Female
Name: Date of Birth: Age:
Home Address: Apt/Unit:
City: State: Zip Code:
Cell Phone: Home Phone:
Email:
Ethnicity (check one): African American Asian Caucasian Latino Other:_____________
Grade: School: Dismissal Time: Student ID#:
Have you ever applied to be a Big Brother / Big Sister before? Yes No If so, where? ___________________
How were you referred to Big Brothers Big Sisters of OC/IE?
Parent/Guardian Information
Mothers/Guardian Name: Cell Phone:
Fathers Name: Cell Phone:
Emergency Contact (other than parent)
Name: Relationship to volunteer:
Home Phone: Cell Phone:
References (MUST include 2)
Parent, Teacher or other Adult who knows you well Friend
Name: Name:
Phone: Phone:
Email: Email:




Pg. 2/5



ADDITIONAL VOLUNTEER INFORMATION
Please mark boxes indicating any of the following health conditions:

Asthma Diabetes Seizures Other _________________________________

Allergies List allergies: ____________________________ (ex. Peanuts, bees, penicillin)

List any medications you take (ex. EpiPen, Inhaler): _______________________________________________

CONSENT AND RELEASE FORM

1. I hereby give consent to Big Brothers Big Sisters of Orange County and of the Inland Empire (BBBSOC&IE) to
use photographs and/or stories about my participation in the Big Brothers Big Sisters Program, in their
public relations and publicity activities.

2. I authorize BBBSOC&IE to obtain medical and/or surgical treatment in case of illness, accident, or any
situation that may arise. These medical services are to be performed by ______________________ or in
his/her absence, any licensed medical doctor. I further state that I will not hold BBBSOC&IE liable in case of
illness, accident or emergency situation.

3. I give permission for BBBSOC&IE staff to talk with my child about personal safety.

4. I understand that all the information obtained through the enrollment process is the sole property of
BBBSOC&IE and that I relinquish my rights to access this information.

5. I understand that if I am not accepted into the program, I will not be provided with an explanation.

6. I understand that if I am accepted into the program, at least one full year commitment is required. If I do
not uphold this commitment without a valid reason, I understand that I am not eligible to receive credit for
service hours already completed.

7. I attest that all the information provided on this enrollment form is to the best of my knowledge true and
accurate and that I fully understand all the questions and statements herein.

PARENTS SECTION

I, ________________________________ give permission for my child to participate in the BBBSOC&IE High School
Bigs Program. I have read and agree to the above consents/releases.

________________________________________ _____________________
Participants Signature Date

_________________________________________ ______________________
Parent/Guardian Signature Date

_________________________________________
Printed Name of Parent/Guardian




Pg. 3/5


CONSENT AND RELEASE FORM
Please initial one of the two boxes below and sign the bottom of the form


________ (init.) I hereby accept the invitation of Big Brothers Big Sisters of Orange County and of the
Inland Empire (BBBSOC&IE) to appear and be identified in print in any BBBSOC&IE publication or
production, or grant the right to use the image of the minor child as specified below.

I hereby grant to BBBSOC&IE and its affiliates the right to use this image, name, and biographical
information as they may desire, in all media and in all forms including, but not limited to, publications, any
televised photography and recordings. Examples include, but are not limited to, print news media,
televised news media, promotional print media and website.

In consideration of $0 to me paid, I hereby grant to BBBSOC&IE and its affiliates the absolute right to use
this image made through BBBSOC&IE studios or elsewhere, in whole or in part, in true or distorted
character or form, alone or in conjunction with any other image, name or reproduction, in color or
otherwise, for art, advertising, business, trade, or any other lawful purpose whatsoever, in perpetuum.

I hereby release BBBSOC&IE and its affiliates from all claims, demands or liabilities and related financial
costs that I may now or hereafter have arising in connection with BBBSOC&IE exercise of the right hereby
granted, with my (or minor childs) appearance in any publication or production. These include, without
limitation, claims for compensation, defamation, or invasion of privacy, or other infringements or violations
of personal or property rights of any sort whatsoever.


________ (init.) I do not grant BBBSOC&IE the right to use the image of the minor child as specified above.



_________________________________________ _____________________
Participants Signature Date

_________________________________________ _____________________
Parent/Guardian Signature Date

_________________________________________
Printed Name of Parent/Guardian











Yes
No




Pg. 4/5


REFERENCE CHECKS FORM
Volunteer Applicant Name:
Reference Name: Phone Number:

1. How long have you known the volunteer (Years/Months)?
2. In what capacity do you know the volunteer (your relationship to him/her)?
3. Can you tell me about a time when you observed the volunteer around a child/children?



4. What was your impression or feelings about that interaction?



5. Do you know of any reason(s) why being a Big Brother/Big Sister may not be the right volunteer experience
for this applicant?



6. Do you know of any reason(s) why this may not be the best time for this applicant to commit to being a Big
Brother/Big Sister? *Volunteers are required to commit to one hour per week, afterschool, for the entire school
year.


7. What else would like to tell us about this applicant?









Pg. 5/5


REFERENCE CHECKS FORM
Volunteer Applicant Name:
Reference Name: Phone Number:

1. How long have you known the volunteer (Years/Months)?
2. In what capacity do you know the volunteer (your relationship to him/her)?
3. Can you tell me about a time when you observed the volunteer around a child/children?




4. What was your impression or feelings about that interaction?



5. Do you know of any reason(s) why being a Big Brother/Big Sister may not be the right volunteer experience
for this applicant?


6. Do you know of any reason(s) why this may not be the best time for this applicant to commit to being a Big
Brother/Big Sister? *Volunteers are required to commit to one hour per week, afterschool, for the entire school
year.


7. What else would like to tell us about this applicant?