In School Mentoring Application Form - Big Brothers Big Sisters of Ottawa

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School Information

Name of School *

Name of Teacher/School Contact *

First

Last

School Liaison Email Address *

Confirm Email

Please provide email address of school staff who provided you with this form.

Grade

Child’s Personal Information

Child’s Legal Name *

First

Last

Preferred Name

Pronouns

Date of Birth (MM/DD/YYYY) *

Gender *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Cell Phone *

Home Phone

Alternate Phone

Parent/Guardian Email *

Preferred Language of Correspondence

English
French

Other Languages Spoken

Emergency Contact Name *

First

Last

Relationship to Child *

Emergency Contact Phone Number *

Mentee’s Country of Origin *

Ethnicity *

Mentee’s Immigration Status *

How long has the mentee been in Canada? *

Less than 5 years
More than 5 years

Is the mentee Francophone? *

Is the mentee part of the 2SLGBTQIA+ community? *

Is the mentee living in care? *

(e.g., Foster Care, Kinship, Adoption)

Does the mentee live in a rural area? *

Does the mentee have disabilities? *

(e.g., Vision, Hearing, Learning, Developmental or Cognitive, Mobility, Speech/Language, Coordination)

Are you Indigenous? *

Please check boxes that apply.

First Nations
Métis
Inuit
Other

Primary Caregiver Name *

First

Last

Cell Phone *

Work Phone

Relationship to Child *

Why does your child want to be a mentee? *

Check any characteristics that describe your child. *

Friendly
Shy
Outgoing
Withdrawn
Active
Other:

Please specify.

Check any of your child’s interests. *

Cooking
Music
Games
Animals
Crafts
Other:

Please specify.

Does your child have any specific medical conditions, allergies, or other concerns we should know about? *

Please elaborate. *

What classes would you prefer your child not miss? *

Is there anything we should know to help us find the right mentor for your child?

Please describe. *

Would you like to be present when your child meets their mentor for the first time? *

Would you like to receive a copy of the pre-match training material? *

Would you like to receive updates about the mentoring relationship? *

of Birth Grade

Pre-Match Training

All children in the program must complete Pre-Match Training, aligned with Ontario’s Health and Physical Education and Social Studies curricula. This training will cover:

Program guidelines and goals
Roles of Littles and Bigs
Healthy relationship development
Physical and social boundaries

Consent

Please check all boxes to indicate your consent. *

I consent to my child participating in an orientation session delivered by the School Liaison.
I consent to my child participating in a program evaluation at the end of the program.
I confirm that the information provided in this application is true and correct and has been given freely.

I hereby consent to Big Brothers Big Sisters of Canada (National Office) and its associated member Big Brothers Big Sisters of Ottawa 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.

Do you agree? *

Parent/Guardian Signature *

Clear Signature

School Information

Child’s Personal Information

Pre-Match Training

Consent

Quick Links

Mentoring Programs