Big Brothers Big Sisters of the Battlefords & District

Big Brothers Big Sisters

Volunteer Enrollment Form

Thank you for your interest in becoming a volunteer with Big Brothers Big Sisters of the Battlefords. Prior to participating in our interview process, please answer the following questions: this will help us tailor the interview to your particular situation. Your answers will be kept confidential. Please note, your answers to these questions will not determine whether you are approved as a volunteer; they are simply a guide for us in the interview. Please fill out all information.

Note that fields marked with an * are required.

If you have already spoken to a caseworker at our office, please enter their name (if known):

Employment information

* What is your occupation?: (If student, please indicate program)
* Employer:
* Work address:
* Work telephone:
Can you be contacted at work?:	Yes No
If yes, what hours do you work?:
Best time to call (work):
* Length of time at present employment:
Does your work take you out of town for extended periods of time?:	Yes No

References The names of the first three references are required. All of the references must be at least 18 years old and have known you for two years. If you have not had an employer for two years, your current employer's reference is required with a professional reference (volunteer, professor, etc), who has known you for two years. The fourth reference is also required if you have worked or volunteered with children. Each one will be contacted to ask for information regarding your suitability to act as a volunteer mentor.
Note: References can't be your spouse, girlfriend/boyfriend, or partner.

If you wish to provide references later, please leave this section blank.

Employer reference

Name of present employer:
Address:
City:
Postal code:
Time known:
If less than two years, an additional reference will be requested.
Occupation / name of firm:
Telephone (home):
Telephone (work):
Email address:

Parents

Name(s) of parent(s):
Address:
City:
Postal code:
Occupation / name of firm:
Telephone (home):
Telephone (work):
Email address:

Friend

Name of friend:
Address:
City:
Postal code:
Occupation / name of firm:
Telephone (home):
Telephone (work):
Email address:
Time known:
If less than two years, an additional reference will be requested.

Organization

Please enter information about an organization in which you have worked/volunteered with children (if applicable).
Name of organization:
Address:
City:
Postal code:
Contact person:
Telephone (home):
Telephone (work):
Email address:

Volunteer Permission and Release Form

Please read the following permission and release form, then check the "I agree" checkbox at the bottom.

Terms and conditions:

I hereby authorize Big Brothers Big Sisters of the Battlefords to contact any or all of the references listed herein for the purposes of processing my application to become a volunteer in the Agency's program. I understand that these references will be contacted in confidence.
 
I further authorize any individuals, firms, corporations, government or other regulatory departments, and Police Department or other organization to release information and copies of documents pertaining to myself to Big Brothers Big Sisters of the Battlefords in order to consider my application to volunteer in the Agency's Program, on the understanding that such information will be held in strict confidence.
 
I acknowledge and accept that this application does not guarantee acceptance into the program, and that Big Brothers Big Sisters of the Battlefords is under no obligation to accept or assign me as a volunteer in their program, and is not obliged to provide a reason.
 
I hereby release and forever discharge Big Brothers Big Sisters of the Battlefords and their employees, directors and volunteers from any cause of action or claim for damages, whether bodily injury, death, property damage, or emotional trauma, anxiety of distress arising from my Agency with Big Brothers Big Sisters of the Battlefords.
 
If I am matched, I understand that I am solely responsible for the care of the Child with whom I am matched during outings and activities. I agree to have constant supervision while the Child is in my care.
 
I give permission for Big Brothers Big Sisters of the Battlefords to release pertinent information regarding my file to the Parent of the Child in the process of match selection. Further, I agree to allow my file to be viewed by Agency Reviewers for Big Brothers Big Sisters of Canada, at the time of the agency review, should it be requested. I further grant Big Brothers Big Sisters of Saskatoon and Area, Inc. permission to release my name, date of birth, agency applied to and notice of acceptance or rejection to Big Brothers Big Sisters of Canada and for relevant details to be shared within the movement.
 
I understand this application and subsequent information in my file is the property of Big Brothers Big Sisters of the Battlefords I understand that if Big Brothers Big Sisters of the Battlefords should cease operation, my complete file becomes the property of Big Brothers Big Sisters of Canada.
 
The implications of the waiver have been explained to me. I understand and consent to them. I further agree that this waiver is made of my own free will and without duress.

Do you agree to the terms of this form?:

I agree You must agree to the terms and conditions.

Once you have filled out all the required fields, click the Send button below. You will be contacted for an in-person interview at a later date. Thanks again for your interest in volunteering with Big Brothers Big Sisters of the Battlefords.