Teen Mentor Application Form

Big Brothers Big Sisters Central Southern Interior of B.C. embodies the principles of diversity and welcomes participation regardless of race, religion, culture or sexual orientation.

Step 1 of 4

References
Please provide two references (a school and personal) that know you well and are 19 years of age or older. Your personal reference must have known you for at least two years. We will contact them via the email address you provide. If your personal reference does not have an email address, please contact your Mentoring Coordinator. Please make sure that you have notified your references that our agency will be contacting them in regards to your application.
1. School Reference
A school reference can be a teacher, counsellor, vice-principal or principal at your current school that knows you well. If you have not attended your current school for at least one semester or term, you can use a reference from your previous school.
School Name*
Reference Name*
Position
Email
2. Personal Reference
A personal reference refers to anyone other than a family member who knows you well and on a personal level. They could be could be your coach, employer, religious leader or family friend but may not be related to you and must have known you for at least 2 years.
Name*
Relationship*
Email*
Phone Number*
Emergency Contact Information
Please provide information for a close friend or family member we may contact in the event of an emergency.
Emergency Contact Name*
Relationship*
Home Phone*
Alternate Phone

Volunteer Permission and Release Agreement
TO: [BIG BROTHERS OF GREATER VANCOUVER] (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:
- 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;
- 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;
- 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
- 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:
- 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.
- 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.
- 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;
- 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, willful 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 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.
- In entering into this Agreement, I am not relying on any oral or written representations other than as set forth in this Agreement.
- This Agreement shall be governed by and construed pursuant to the laws of the Province or Territory in which the Agency is located.
- 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.
If you do NOT agree with item #6 Media Consent, please check here:
- I do not agree with item #6 Media Consent
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.
Please check if you have read, understand, and accept the above Agreement.*
- I have read, understand, and accept the above Agreement
IMPORTANT: 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 legal rights, including the right to sue. I further agree that such limits are reasonable and sign this Agreement freely, voluntarily and without duress.

THANK YOU! ONLY THOSE APPLICANTS THAT MEET OUR REQUIREMENTS WILL BE CONTACTED FOR AN INTERVIEW. PLEASE ACCEPT OUR APPRECIATION FOR YOUR INTEREST!
Confidentiality Policy
All staff and volunteers of AGENCY 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 the 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 Big 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.*
- I understand the agency's policy around confidentiality and agree to abide by those rules

Teen Mentor Application Form

Step 1 of 4

Application Form

References

1. School Reference

2. Personal Reference

Emergency Contact Information

Volunteer Permission and Release Agreement

THANK YOU! ONLY THOSE APPLICANTS THAT MEET OUR REQUIREMENTS WILL BE CONTACTED FOR AN INTERVIEW. PLEASE ACCEPT OUR APPRECIATION FOR YOUR INTEREST!