Group Program Application Form

Dear Parents/Guardians,

Big Brothers Big Sisters offers group programs throughout the year. A group of 5-10 students will be facilitated by 1-2 leaders (female facilitators for Go Girls, male facilitators for Game On, with either gender facilitating Play On). Due to the current pandemic, group sessions will be delivered on a virtual platform (Zoom, or via the Mentor-to-Go app, to be launched in early 2021) and when it is safe to do so, we will provide in-person physically-distanced programming.

Group programs consist of seven to ten, 1.5 hour sessions held on a predetermined weekday. Each session is fun-filled, active, and informative. Our group programs strive for the following: • create appreciation for the benefits of an active, healthy lifestyle • build understanding of what constitutes healthy eating habits • promote the importance of positive mental activity and regular physical exercise • encourage awareness of core values, personal interests, strengths and attributes • support the development of leadership and life skills • offer guidance in establishing and maintaining friendships • encourage leadership skills and independent thinking. The first session will include child safety training information reviewed in the Strong from the Start program through Big Brothers Big Sisters of Canada. As part of the program, participants will be asked to complete an anonymous evaluation informing us about their experience with the program. This information could be used to make program improvements and determine impact.

To register for this program, please complete and submit this form. Incomplete applications will not be accepted. Your child may withdraw from the program at any time. If you would like to learn more about this program please contact Big Brothers Big Sisters of Central Vancouver Island 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?
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  • This information will help our group facilitators best support your child.
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  • Informed Consent

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  • ASSUMPTION OF RISK, RELEASE AND INDEMNITY AGREEMENT

  • Child/Youth
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  • 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.