Community Mentoring Application Form

Dear Parents/Guardians,

The Community Mentoring Program matches children/youth (aka a “Little”) aged 6-16, to an adult (aka a “Big”) aged 19 years or older. Matches spend one-to-one time together for the duration of 2-4 hours per week. Matches can participate in variety of mutually-agreed-upon activities such as arts & crafts, puzzles, sports, reading, games, board games, outside activities, etc. Due to the current pandemic, match meetings are currently being conducted on a virtual platform (Zoom, or other compatible platform, or via the Mentor-to-Go app, to be launched in early 2021) and when it is safe to do so, we will provide meetings in person.

Mentors in this program have been screened, interviewed, trained and have completed a criminal record check including a vulnerable sector check. This experience is meant to provide children/youth with a positive mentoring relationship that they can look forward to each week, learning new things while increasing self-confidence. All children/youth participating in this program must attend a Child Safety Program - Strong from the Start. If your child/youth is matched in this program, we ask that you talk to your child about the activities they participate in with their mentor to ensure they feel comfortable at all times. We invite you to complete and submit the application, & consent and release form below in order to facilitate your child being matched in the Community Mentoring Program.

Big Brothers Big Sisters of Central Vancouver Island is committed to providing a positive mentoring experience for your child. If you have any questions or concerns at any time, please call the office at 250-756-2447.

PLEASE NOTE: This information will be updated regularly to reflect any and all Public Health Orders surrounding Covid-19.

  • Response to this question is voluntary. Information will be used for statistical purposes only.
  • At what phone number can we reach you during the day?
  • Please provide details.
  • This information will help our group facilitators best support your child.
  • Although you do not have to be involved in any particular way, the following options are available to you:
  • MM slash DD slash YYYY
  • INFORMED CONSENT

  • MM slash DD slash YYYY
  • ASSUMPTION OF RISK, RELEASE AND INDEMNITY AGREEMENT

  • Child/Youth
  • MM slash DD slash YYYY
  • ASSUMPTION OF RISK, RELEASE AND INDEMNITY AGREEMENT - CONSENT

    The information being collected by the Agency is being collected for the express purpose of operating the mentorship program and will be used and may be disclosed to staff and volunteers as required for such purpose.
  • MEDIA CONSENT

  • I hereby consent to Big Brothers Big Sisters of Canada (National Office) and its associated member Big Brothers Big Sisters of Central Vancouver Island the use of any photographs, audio and/or video recordings of my child or youth as taken or produced by media personnel and/or National Office or Local Agency staff at recreational events or match outings, or otherwise authorized by the National President & CEO, local agency President/Executive Director/CEO or Board of Directors, and that this media may be used by Local Agency and/or by the National Office for purposes of promotional material including brochures, posters, newsletters, media information, advertisements, audio-visual productions and digital media, (such as the local agency websites and social media). Photographs or video productions may also be shared with community and school partners for program promotion. Note: It is the parent/guardian’s responsibility to notify the office if the status of this consent changes.