GO GIRLS and GAME ON program registration - Big Brothers Big Sisters of Eastern Newfoundland

About Go Girls and Game On

Go Girls and Game On group mentoring programs are a FREE 4-6 week program designed for youth between the ages of 10-13. The group meets weekly in school for 1 hour via a school approved virtual platform such as Google Meet.

Groups will be led virtually by 2-3 fully screened (Criminal Record Check included) and trained Go Girls or Game On Facilitators. It will also be supported by school staff as well as the BBBS School-Based Mentoring Coordinator. The program encourages young people to be more active and lead healthy lives by providing them with information and support to make informed choices about a range of healthy lifestyle practices. Young people come together in a group to engage in both traditional and non-traditional physical activities, games, and self-awareness activities.

In addition to the physical activity component, participants will also be encouraged to take part in discussions about the importance of balanced eating, healthy relationships, assertiveness and just being you!

This program is run by Big Brothers Big Sisters of Eastern Newfoundland; an organization with 45 years experience of mentoring and creating a positive impact in the lives of children and youth.

Child/Youth's Name*

First Last

Child/Youth's Birthdate*

Child/Youth's Gender Identity*

Female
Male
Transgender
Non-Binary
Other

Does the child/youth have any dietary restrictions or allergies?

Please list below.

Child/Youth's Current Grade*

Child/Youth's Current School*

Family Contact Information

Name of Primary Parent/Guardian*

First Last

Relation to Child/Youth*

Parent
Guardian
Other

Family Address*

Street Address Address Line 2 City Province Postal Code

I am the parent/guardian of the child/youth for whom I am making this application.*

Yes
No

Family Phone Number*

Family Email*

This email will be used to communicate with the Parent/Guardian of the student participating in group mentoring programs.

Enter Email Confirm Email

About the Child/Youth

Please note the following responses are voluntary, and the information is used for statistical purposes only.

Does the child/youth have any diagnosed disorders/behavioural concerns/medical conditions we should know about?

Program Consent

Informed Program Consent*

I hereby give permission to BIG BROTHERS BIG SISTERS OF EASTERN NEWFOUNDLAND to make available their service to my child. It is my understanding that the intention of the Agency is to offer my child an opportunity to participate in a group program lead by a responsible adult, (minimum 18 years old, however, where appropriate supervision takes place, the volunteer may be younger), I understand that all efforts will be made to select a responsible Mentor who will facilitate the group program.

In consideration for this service and other valuable consideration provided to my child by BIG BROTHERS BIG SISTERS OF EASTERN NEWFOUNDLAND, I release the agency of all responsibilities and liabilities in connection to their services provided in good faith, to myself or my child. I permit the agency to release any relevant information, including my personal information, to Big Brothers Big Sisters of Canada and their insurers, as may be appropriate in connection with any legal proceeding, inquiry or risk thereof.

I understand that the collection of personal information about me or my child will be held in strict confidence and is to be used solely for the purposes of administering the program. I further agree that information about my child may be shared, at the discretion of BIG BROTHERS BIG SISTERS OF EASTERN NEWFOUNDLAND, with the group facilitator so that my child’s needs may be best met. I understand that this application is the property of BIG BROTHERS BIG SISTERS OF EASTERN NEWFOUNDLAND. I also agree that my child will participate in the Pre- Match Training Program administered by BIG BROTHERS BIG SISTERS OF EASTERN NEWFOUNDLAND.

I HAVE READ AND UNDERSTAND THIS AGREEMENT. BY CHECKING "YES" TO THIS AGREEMENT, I ACKNOWLEDGE THAT: I am the parent/guardian of the child mentioned above, and I hereby request Big Brothers Big Sisters service for my child. I give my child permission to participate in one or more group programs offered by BIG BROTHERS BIG SISTERS OF EASTERN NEWFOUNDLAND. 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.

Yes

Photo Consent (Program Promotion/Awareness Raising)*

Any photographs or video productions taken of children or youth 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 the 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 for program promotion. My child’s FIRST name only, general personal circumstances, and general information about their match may be included.

Yes
No

The person who filled out this form and gave consent for the child/youth to participate in group mentoring programs*

First Last

Please email gale.martin@bigbrothersbigsisters.ca if you have any questions about this program or the application process. Thank you!

Big Brothers Big Sisters of Eastern Newfoundland respects your privacy and adheres to personal information privacy legislation. The information provided will be used to create a confidential client file.