Informed Consent (Community-Based) – Parent/Guardian

  • I have read and understand this agreement. By signing this agreement, I acknowledge that as the parent/guardian, I hereby request Big Brothers Big Sisters services for my child. I give the agency my consent to assign a Mentor to my child. I am aware of and understand the risks, dangers and hazards associated with the above service and agree such service is suitable for my child.

  • MM slash DD slash YYYY
  • Note: Release to share information with other professionals will expire within one year of the above date