YOUTH APPLICATION

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BBBS of Southern Maine Volunteer Application

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Big Brothers Big Sisters Commitment + Communication Policy

Community-Based Program Requirements:

We ask for a 1-year commitment from the time you are matched with a child/youth.
You are required to meet with your Little weekly or bi-weekly, depending on the your schedule and the families.

Site-Based Program Requirements:

We ask for a 3-semester commitment from the time you are matched with a child/youth.
You will meet weekly at school, in an after-school program or virtually.

Our standards require that each volunteer, child, and parent must complete regular, scheduled support contacts. For the first year of the match, contacts will follow a monthly cycle, moving to every three months after the one-year anniversary of the match. The contact may take place by phone, email, text or in person.

Non-Discrimination Policy

All applications will be given equal consideration regardless of race, age, sex, disability, marital status, sexual orientation, gender identity, religion or national origin.

Hidden Fields

Contact ID 18 Character

Enrollment ID 18 Character

Contact Owner ID

Contact Owner Email

Basic Information

First Name

Middle Name

Last Name

Maiden/Alias

input NA if none

Preferred Name

Birthdate

Gender

How do you identify?

Personal Pronouns

What pronouns do you use?

Race/Ethnicity

American Indian or Alaska Native	Asian - Chinese
Asian - Filipino	Asian - Indian
Asian - Japanese	Asian - Korean
Asian - Other	Asian - Vietnamese
Black or African American	Hispanic - Cuban
Hispanic - Mexican,Mexican American, or Chicano	Hispanic - Other Latinx or Spanish origin
Hispanic - Puerto Rican	Middle Eastern or North African
Pacific Islander - Chamorro	Pacific Islander - Native Hawaiian
Pacific Islander - Other	Pacific Islander - Samoan
White or Caucasian	Other
Prefer not to say

Tribal & Regional Corporation Affiliations

Nationality

To select multiple, hold CTRL/CMD and click.

Are you applying as a:

Name of Your School:

Graduation Year:

Please upload a copy of your school ID

File can be a screenshot, PDF, or picture

Relationship Status

Do you have a driver's license?

Driver's License Number

Driver's License State

Driver's License Expiry

Please upload a copy of your license

File can be a screenshot, PDF, or picture

Auto Insurance Effective Date

Auto Insurance Company

Please upload a copy of your auto insurance.

File can be a screenshot, PDF, or picture

Contact Information

Personal Email

Work/School Email

Alternate Email

Preferred Email

Mobile Phone

Work Phone

Work Phone Extension

Home Phone

Alternate Phone

Preferred Phone

Best Time to Call

In general, do you prefer to be contacted by email or phone?

Mailing Address

Mailing Street Address

Mailing City

Mailing State

Mailing Zip Code

Mailing County:

Mailing address is different from residential address

Physical Address

Street Address

City

State

Zip Code

Emergency Contact Information

Name

Phone

Relationship

Employer Information

Employment Status

Name of Employer

Occupation

Employment Length (Months)

Employment Length (Years)

Employer Address Line 1

Address Line 2

City

State

Postal Code

Is it okay to call at work?

YesNo

Additional Information

Which program are you applying for?

In which county would you prefer to be matched?

Level of Education

Year Degree Obtained

Education Years Completed

Have you served in the military?

How would you describe yourself, in terms of participation in events, activities, or sports?

Which activities do you enjoy more?

How did you hear about Big Brothers Big Sisters of Southern Maine?

Was your referral directly related to our "60 in 60 Campaign"?

YesNo

Name of Current/Alumni Big:

Name of Current/Former Board/Staff Member:

Name of Workplace:

Event Location:

Referral Detail ID

Criteria Required to be Accepted as a High School big

willing and able to commit to meet with their Little for 1 hour every week that school is in session
willing and able to make a commitment for a minimum of three school semesters
willing and able to commit to not be involved in any activities that will prevent them from meeting with their Little once each week that school is in session for the length of their commitment (i.e. sports, a job during the school year, etc.)

students in good standing at their school, based on the guidelines that the school requires for participation in extra-curricular activities

The Reasons for the Criteria

When you become a Big, you are making a promise to a younger, more vulnerable person. Consistency and follow through is essential to this mentoring relationship.

Research has shown that when a Big Brother or Big Sister does not follow through with his/her weekly commitment to their Little for more than a year, it does not just have a neutral effect; it has a negative impact on that child. That is why we require all high school Bigs to make a commitment of a minimum three semesters (18 months) to their Little.

We know that the longer a Big and Little are consistently together, the greater the impact the Big will have on that younger person’s life, even if it may not be evident at that time. For this reason, we focus primarily on recruiting freshmen, sophomores and juniors who are able to be consistently matched with the same Little for at least 2 school years.

References and Background Check

Previous Experience

Have you previously applied to be or served as a Big here or anywhere else?

YesNo

When?

Where?

Have you ever been involved with Big Brothers Big Sisters in a capacity other than a Big?

YesNo

When?

Where?

Have you ever been denied acceptance or released from service as a volunteer or employee or another Big Brothers Big Sisters Program for another youth-serving organization?

YesNo

When?

Where?

Have you previously worked as a volunteer or paid staff with a youth serving organization in the last 5 years?

YesNo

Volunteer Experience

YSO Reference ID

Organization Name

Location

Start Date

End Date

Direct Supervisor First Name

Direct Supervisor Last Name

Phone

Email

Years Known

Reason for Leaving

Please provide at least three references below including:

Your spouse/domestic partner OR a family member if you do not have a spouse, partner, or significant other. If you live with your partner, we require that they complete this reference.
Current or former employee or co-worker you have known for at least one year or someone from your school if you are a student
A personal reference from a friend or neighbor you have known for at least two years

Spousal/Familial Reference

Spousal/Familial Reference ID

First Name

Last Name

Email

Phone

Relationship to you

Years Known

Professional Reference

Professional Reference ID

First Name

Last Name

Email

Phone

Relationship to you

Years Known

Minimum 1 year

Personal Reference

Personal Reference ID

First Name

Last Name

Email

Phone

Relationship to you

Years Known

Minimum 2 years

I consent to and understand that:

The references and youth-serving organization(s) I listed may be contacted by mail, telephone, email, or in person;
The information I provided may be used to conduct a background check, to include a search of public domain records, driving records, juvenile and adult criminal history check (see attached authorization), military records, and other records where required by local, state, or federal law for volunteers working with youth;
I am in no way obligated to perform any volunteer services;
The BBBS of Southern Maine agency is not obligated to match me with a child/youth and may deny my application or close my match at any time, and to protect all participants’ confidentiality, BBBS of Southern Maine is not required to disclose reasons for doing so;
Other BBBS agencies and youth organizations where I have worked or volunteered may be contacted as references;
As part of the enrollment processes, I will be required to provide additional personal information, including completion of an in-person interview;
I understand that the information I provide in the enrollment process will be kept confidential, unless disclosure is required by law.
I understand that detailed accounts of child abuse or neglect, past or present, will be reported to proper authorities;
I understand that certain relevant information about me will be discussed with the parent/guardian of a child who is a prospective match (this might include demographic information, information relevant to parent/child preferences, and any information relevant to a child’s safety or well-being);
It is my responsibility to update the agency if any of the information I provide on this application, in my interview, or any other information provided during the enrollment process changes (i.e. address, phone number, auto-insurance, new criminal charges, etc.)
I agree to complete questionnaires throughout my time in the program to evaluate and improve program services;
I agree to timely communication and follow-up with all agency staff as required by the agency.

I accept the terms and conditions

Reference Information

Parent/Guardian Reference

Spousal/Familial Reference ID

Please provide at least two references below including:

Your parent or guardian
Current or former teacher, counselor or coach you have known for at least one school year

First Name

Last Name

Email

Phone

Relationship to you

Years Known

Teacher/Counselor Reference

Professional Reference ID

First Name

Last Name

Email

Phone

Relationship to you

Years Known

Minimum 1 year

Have you previously worked as a volunteer or paid staff with a youth serving organization in the last 5 years (including babysitting)?

Volunteer Experience

YSO Reference ID

Organization Name

Location

Start Date

End Date

Direct Supervisor First Name

Direct Supervisor Last Name

Phone

Email

Years Known

Reason for Leaving

Pre-Interview Questionnaire

Prior to your in-person interview, please answer the questions below. The information you provide will also help us make a better match for you and assure we can support you during your involvement with our program. Please note that you will have an opportunity to discuss these questions and your responses more thoroughly during your in-person interview.

Do you have any concerns about your ability to fulfill the 12-month commitment required of mentors?

YesNo

Please explain:

Are you interested in being connected with a current volunteer to discuss their experience navigating our enrollment process and being a mentor to a child/youth in their community? You may opt in/out of this opportunity at any time.

YesNo

Do you anticipate any significant life changes over the next year or have you had any this past year? (ie. job or schedule changes, moving, new family member, etc.)

YesNo

Please describe:

Have you ever been accused, arrested, charged, or convicted of a crime?

YesNo

Please describe:

Have you had any driving citations and/or moving violations in the past five years?

YesNo

Please describe:

Do you have guns, ammunition, or other weapons in your house?

No GunsGuns Secured

I agree to inform BBBS of Southern Maine should I purchase or acquire a weapon/ammunition that will be present in my home during the time I am actively matched with a child in the program.

Agency Weapons Policy

As a volunteer, I agree to keep any weapons and ammunition inaccessible to the child assigned to me by BBBS of Southern Maine while he/she is in my custody.

What languages do you speak fluently? (select all that apply)

African Languages (Swahili, Bantu)	American Sign Language
Arabic	Asian: Other
Chinese	Creole
Dutch	Eastern European (Czech, Slovak)
English	French
German	Greek
Hebrew	Hmong
Indian (Hindi, Punjabi)	Italian
Japanese	Keres (West)
Korean	Lao
Nordic	Persian
Portuguese	Russian
Spanish	Turkish

Would you be able to secure or otherwise make unavailable any inappropriate viewing materials in your home, including television channels and internet access?

YesNo

Do you have any pets in your home?

YesNo

Please list all pets including age, size, breed, and their experience around children.

Are you currently in counseling or therapy?

YesNo

If yes, an additional reference may required. Please list the name and contact information for your provider.

Have you been hospitalized for any mental health issues in the past five years?

YesNo

If you are comfortable sharing, please explain the reason for your hospitalization.

Are you experiencing any physical health issues?

YesNo

Have you received the COVID-19 Vaccine?

Are all eligible others living in your household vaccinated against COVID-19?

Please describe:

Do you have a religious affiliation?

YesNo

Please choose:

How do you identify in terms of sexual orientation?

Are you comfortable working with a child or family members that may have a different sexual orientation than your own?

YesNo

Do you have any children?

YesNo

Please list their ages and gender:

Have you moved in the last 5 years?

YesNo

Please list all residences in the last 5 years:

City/State

From

Are there other people residing in your household?

YesNo

Please provide the name, age, and relationship to you for anyone else residing in your home:

Name:

Age:

Relationship to you:

Is there anything else you'd like to share with us at this time?

Are you interested in learning about additional ways to contribute to the Big Brothers Big Sisters mission? Check all that apply.

Becoming a donorHelping to recruit volunteersVolunteering at agency events for matches, Littles, waiting-list children, etc.Volunteering at agency fundraising eventsInviting BBBS to speak at a company, church, organization, or other group of which I am a memberI am not interested in contributing in other ways at this time

Pre-Interview Questionnaire

Is there anything that will prevent you from fulfilling your weekly commitment to your Little Brother/Little Sister for the three-semester requirement? (work, sports, etc.)

YesNo

Please explain:

Do you anticipate any significant life changes over the next year or have you had any this past year? (ie. job or schedule changes, moving, new family member, etc.)

YesNo

Please describe:

What days of the week/time will be best for you to meet with your "Little"?

In what district are you hoping to be matched?

Do you have transportation available to your selected site?

YesNo

Are you experiencing any physical health issues?

YesNo

Please describe:

Have you ever been accused, arrested, charged, or convicted of a crime?

YesNo

Please describe:

What languages do you speak fluently? (select all that apply)

African Languages (Swahili, Bantu)	American Sign Language
Arabic	Asian: Other
Chinese	Creole
Dutch	Eastern European (Czech, Slovak)
English	French
German	Greek
Hebrew	Hmong
Indian (Hindi, Punjabi)	Italian
Japanese	Keres (West)
Korean	Lao
Nordic	Persian
Portuguese	Russian
Spanish	Turkish

Do you have a religious affiliation?

YesNo

Please choose:

How do you identify in terms of sexual orientation?

Are you comfortable working with a child or family members that may have a different sexual orientation than your own?

YesNo

If no, please explain why:

Please provide the name, age, and relationship to you for anyone else residing in your home.

Name

Age

Would you describe yourself as a person who enjoys:

Watching events/activitiesActively participating in activitiesBoth

In identifying a youth for you to work with, are there any special considerations you want us to know about? (If yes, we will have you discuss this during your in person interview)

YesNo

What are your favorite subjects?

What are some of your hobbies?

Do you like sports?

YesNo

Which are your favorites?

Do you enjoy playing board games?

YesNo

Which ones do you enjoy most?

Do you like arts and crafts?

YesNo

What types?

What experience (s) or characteristics of yours do you think will help you to be a good mentor?

Is there anything else you'd like to share with us at this time?

Activity Interest Form

This form helps us get to to know you better and provides us with valuable information we can use to make the best match for you. Please check the box next to each activity you enjoy.

Playing Sports

BaseballBasketballBowlingCheerleadingField hockeyFootballGolfHockeyKickballLacrosseRollerbladingRoller-skatingSkateboardingSkiing downhillSkiing X-CountrySnowboardingSoccerSwimmingTrackTennisVolleyball

Games

Board GamesCardsCheckersChessFantasy leaguesImaginative playJigsaw puzzlesLegosPing pongPool/BilliardsVideo Games

Arts and Crafts

Bead workDancingDrawingKnitting/CrochetingModel buildingPaintingPhotographyPottery/ClayScrapbookingSewingSingingTheater/ActingWritingWoodworkingPlaying music

Reading

ComicsFictionMagazinesNewspapersNon-Fiction

Indoors

ComputersCookingGoing to the gymGymnasticsKarateListening to musicMoviesTV/VideoWatching sportsWeightliftingYoga

Outdoors

BeachBikingBoating/SailingBoogie boardingCanoeing/KayakingClimbingExploring/NatureFishingFrisbeeGardeningGeocachingGoing to the parkHikingHorseback ridingIce SkatingJoggingPicnicsSleddingSnowshoeingSurfingTaking a walk

Additional

Animal careAttending fairsAuto mechanicsCar racesGoing to the circusConcertsGo-CartsKite flyingMini golfMuseumsVolunteeringWindow shopping

High School Volunteer Consent Form

I consent to and understand that:

1) The references and youth serving-organizations I listed may be contacted by mail, telephone, email, or in-person.

2) The information I provided may be used to conduct a background check, to include an internet search, and criminal history check if the applicant is over 18.

3) I am in no way obligated to perform any volunteer services.

4) The BBBS agency is not obligated to match me with a youth and may deny my application or close my match at any time, and to protect all participants’ confidentiality, BBBS is not required to disclose reasons for doing so.

5) As part of the enrollment processes, I will be required to provide additional personal information, including completion of an in-person interview.

6) I understand that the information I provide in the enrollment process will be kept confidential, unless disclosure is required by law and with exceptions noted below.

7) I understand that incidents of child abuse or neglect, past or present, must be reported to proper authorities.

8) I understand that certain relevant information about me will be discussed with the parent/guardian of a child who is a prospective match (this might include demographic information, my interests and preferences for a Little, information relevant to parent/child preferences, and any information relevant to a child’s safety or well-being).

9) It is my responsibility to update the agency if any of the information I provide on this application, in my interview, or any other information provided during the enrollment process changes, including my address, phone number or email address.

10) I agree to respond to agency staff when they attempt to contact me.

Please read the following carefully before signing this application:

I understand that this is an application for a volunteer opportunity and is not a promise or commitment by Big Brothers Big Sisters that they will make a match for me. I certify that all information I have provided or will provide to Big Brothers Big Sisters, including this application, is true, correct and complete to the best of my knowledge. I certify that I have and will answer all questions to the best of my ability and that I have not and will not withhold any information that would affect my application for a volunteer position. I understand that information contained on my application will be verified by Big Brothers Big Sisters. I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant or my termination as a volunteer.

At any time while involved with the Big Brothers Big Sisters program, I agree to immediately inform my Big Brothers Big Sisters contact person of any and all infractions, violations, charges and convictions related to any civil, domestic, or criminal occurrences. I understand that BBBS staff needs to be fully informed to provide the best support possible.

By checking this box, I agree to the above information presented.

If applicant is under the age of 18, co-signature of a parent/guardian is required:

By checking this box, I give permission for my daughter/son to volunteer as a high school Big Brother or Big Sister. I have read and co-signed, with my child, the Big Brothers Big Sisters Volunteer Application and understand that she/he is committing to be a volunteer mentor for at least 3 semesters (1.5 school years) and that she/he will spend an hour each week that school is in session mentoring a younger person.

Confidentiality and Release of Information
to be read and signed by all Agency Volunteers

The Big Brothers Big Sisters program is designed to help children who have a need for a positive friendship with an interested older person. In order to provide a responsible and professional service to children and volunteers, program participants must share personal information about themselves, in order to be placed in a compatible friendship. Big Brothers Big Sisters will hold this information in confidence, sharing only sufficient information with the volunteer and the child to make the match.

The information provided regarding a potential child or volunteer may include a profile, which may include age, race, religion, family background, current home life, hobbies and interests, school performance, and other information of relevance to matching them.

I acknowledge that I have read and accept Big Brothers Big Sisters’ Confidentiality and Release of Information policy. I understand and agree that agency personnel will obtain personal information about me (such as references and criminal background checks) as deemed necessary. I understand and agree that any party has the right to refuse to continue the match after an initial assessment period.

Permission to Participate In Media & Publicity Efforts:

I hereby authorize Big Brothers Big Sisters to use photos and/or video of my child in the following formats: check all that apply.

WebsitePrint media (including our annual newsletter, monthly E-newsletter, and brochure)Social Media (Facebook, Instagram, Vimeo or Twitter)Please do not use any photos or videos of my child for any publicity purposes

I recognize that I may revoke my permission at any time by submitting a written letter to Big Brothers Big Sisters except to the extent that action has already been taken on the consent.

Social Media Policy

Big Brothers Big Sisters of Southern Maine recognizes that online social networking (Facebook, Twitter, LinkedIn, Instagram, Snapchat, Blogs, etc.) has become a very popular communication tool and that many of our Big Brothers/Sisters and Little Brothers/Sisters use these apps. It is our policy that social media friendships are not permitted with in the first year of the match. In general, personal use of social networking sites is typically for communication between peers, including friends and family. Big Brothers Big Sisters wants to reiterate that a Big’s relationship with his/her Little is that of a mentor, in addition to a friend, and therefore, not all social networking sites are designed to support mentoring relationships. We ask that Bigs proceed thoughtfully when inviting or accepting an invitation from their Little, or Littles family to social networking sites. Bigs will be asked to consult their Program Manager if there is a question about the appropriateness of a friend request. If Bigs do choose to participate in social networking with their Littles, adherence to the following guidelines regarding any postings related to their match or affiliation with Big Brothers Big Sisters is required:

1. Do not participate in any online communication with/about the Little unless approval is given by the parent/guardian and Program Manager first.

2. Bigs must give parents/guardians and Big Brothers Big Sisters of Southern Maine their website address and, when possible, link their page to Big Brothers Big Sisters of Southern Maine’s page on that site so we can follow along with your postings. We are currently active on Facebook.

3. Bigs must never post any pictures of Littles online unless they obtain written consent from the Little’s parent/guardian, and that consent form is filed with Big Brothers Big Sisters.

4. Bigs must never post the last name of their Littles, their parent/guardian or Big Brothers Big Sisters of Southern Maine staff.

5. Bigs must never post any contact information for their Littles.

6. Bigs must never post any identifying information about their Littles.

7. Remember, once you become social network friends, they will see anything you post. All content must be appropriate.

8. Big Brothers Big Sisters of Southern Maine will close your match if these guidelines are not followed.

By checking this box I agree to adhere by the Big Brothers Big Sisters of Southern Maine Social Media Policy as outlined above.

Social Media Check Release

In addition to our multi-layered background check, we perform a social media and google search for all applicants. Please provide any and all active social media handles below. Type N/A if do not have an active account.

Facebook:

Instagram:

Linkdin:

TikTok:

Twitter:

Are your social media accounts private?

YesNon/a

INITIAL RELEASE AUTHORIZATION FOR MAINE CHILD PROTECTIVE SERVICES CASE RECORDS RESEARCH

AGENCY ID#: 119

AGENCY NAME: Big Brothers Big Sisters of Southern Maine

I understand that:

a. If this search shows that I have been involved in a substantiated child protective case, another release by me is required before the nature of my involvement will be disclosed to the agency/service provider identified below.

b. This information will be used as part of the agency/service provider's assessment of my suitability to provide services for children, adults, and families for this agency.

c. This information is subject to continuing confidentiality as provided by Maine statutes Title 22 §4008.

This consent will expire upon the release of the information as authorized.

This consent may be revoked by me in writing at any time, except for information that has already been released.

Agency/Provider to receive this information:

Big Brothers Big Sisters of Southern Maine

625 Main Street

Westbrook, ME 04092

I authorize release of confidential information by the Maine Department of Health and Human Services, Office of Child and Family Services, regarding whether I have been involved in a substantiated Maine Child Protective Services case.

BACKGROUND CHECK REQUIREMENTS

Big Brothers Big Sisters of Southern Maine requires the following background checks be completed for all volunteer applicants prior to the interview:

Maine Criminal History Background Record
National Criminal File request
Department of Motor Vehicles Record
State and National Sex Offender Registry

CODE 22084

PIN # 1203

Big Brothers Big Sisters of Southern Maine

625 Main Street Westbrook, ME 04092

By checking here, I authorize Big Brothers Big Sisters of Southern Maine to run the background checks as described above.

RELEASE OF INFORMATION

To: Division of Motor Vehicles

I hereby authorize the Division of Motor Vehicles to provide the above requested information to Big Brothers Big Sisters of Southern Maine.

Confidentiality and Digital Platform Policies

Big Brothers Big Sisters of Southern Maine

CONFIDENTIALITY AND RELEASE OF INFORMATION

The Big Brothers Big Sisters program is designed to help children who have a need for a positive friendship with an interested adult. In order to provide a responsible and professional service to families and volunteers, program participants must share personal information about themselves, in order to be placed in a compatible friendship. Big Brothers Big Sisters will hold this information in confidence, sharing only sufficient information with the volunteer and the child’s parent or guardian, to make the match.

Specifically, information provided to the parent/guardian regarding a potential volunteer will be as a profile only, with no identifying facts (name, address, etc.) and will include age, race, sexual orientation, marital status, hobbies and interests, reasons for volunteering, home setting, occupation, and the volunteer’s values, beliefs, and experiences, as they relate to his/her participation in the program. The information provided to the volunteer regarding a potential child shall include a profile which includes age, race, religion, family background, current home life, hobbies and interests, school performance, and any other information of relevance. If a child is in counseling, any pertinent information received from the counselor will be shared as well.

I consent to and understand that:

1) The references and youth serving-organization I listed may be contacted by mail, telephone, email, or in-person;

2) The information I provided may be used to conduct a background check, to include a search of public domain records, driving records check, juvenile and adult criminal history check (see attached authorization), military records, and other records where required by local, state, or federal law for volunteers working with youth;

3) I am in no way obligated to perform any volunteer services;

5) Other BBBS agencies and youth organizations where I have worked or volunteered may be contacted as references;

6) As part of the enrollment processes, I will be required to provide additional personal information, including completion of an in-person interview;

7) I understand that the information I provide in the enrollment process will be kept confidential, unless disclosure is required by law and with exceptions noted below.

8) I understand that incidents of child abuse or neglect, past or present, must be reported to proper authorities;

9) I understand that certain relevant information about me will be discussed with the parent/guardian of a child who is a prospective match (this might include demographic information, information relevant to parent/child preferences, and any information relevant to a child’s safety or well-being);

10) It is my responsibility to update the agency if any of the information I provide on this application, in my interview, or any other information provided during the enrollment process changes (i.e. address, phone number, auto-insurance, new criminal charges, etc.).

11) I agree to timely communication and follow-up with all agency staff.

I acknowledge that I have read and accept Big Brothers Big Sisters’ Confidentiality and Release of Information policy. I understand and agree that any party has the right to refuse to enter into the match based upon the information provided.

Photograph/Media Release

I hereby authorize Big Brothers Big Sisters to use photos and/or video of me in the following formats:

Website (www.somebigs.org)Print media (including our annual newsletter, monthly E-Newsletter, and brochure)Social Media (Such as Facebook, Instagram, Vimeo, and Twitter) Please do not use any photos or video of me for any publicity purposes

I recognize that I may revoke my permission at any time by submitting a written letter to Big Brothers Big Sisters except to the extent that action has already been taken on the consent.

Virtual Platform

Big Brothers Big Sisters of America has developed a digital platform to help Bigs and Littles stay in touch more easily in a safe and secure way. Participation requires your permission.

I consent, should I be matched, to having contact with my Little through Big Brothers Big Sisters' digital platform.

Media Consent and Release

I irrevocably consent to any and all uses and displays of my name, image, likeness, appearance, basic biographical information, audio/video recordings, writings, artwork, and the like, in original form or in modified form, in whole or in part, in, on, or in connection with merchandise, advertising, publicity, marketing, fundraising, and the like, in printed or electronic media, of any type, throughout the world at any time by Big Brothers Big Sisters of America and [BBBSA affiliate] in their sole discretion, and by any of their affiliates, successors, partners, sponsors, donors, any entities or persons with whom they conduct any public relations, marketing, or fund raising of any type, and any other authorized third parties, without further consent from me, without any royalty, payment, or other compensation to me, and with the release and waiver of any claims, actions, damages, losses, costs, expenses and liability of any kind arising from any such use (the “Released Material”).

In consideration of the mutual promises made herein, and for other good and valuable consideration, the receipt and sufficiency of which I hereby acknowledge, I hereby grant to BBBSA and its affiliates the right to use the Released Material as BBBSA and/or its affiliates may desire, in all media now existing or hereafter created and in all variations and forms including, but not limited to, internal or external publications or productions, informational or recruitment materials, marketing materials, fundraising materials, televised photography and/or recordings, advertisements, Public Service Announcements, and/or online and social media sites. The use of this information shall be at the sole discretion of BBBSA and/or its affiliates.

I further grant to BBBSA and its affiliates the absolute right to use the Released Material in whole or in part, alone or in conjunction with any other image, name, writings or reproduction, in color or otherwise, for art, advertising, business, trade, or any other lawful purpose whatsoever, in perpetuity throughout the world.

I understand and agree that all materials created by BBBSA and/or its affiliates that use the Released Materials are the property of and are owned by BBBSA, and that I cannot authorize their use by any other party. I further understand that BBBSA may authorize their use by a third party. I hereby irrevocably transfer and assign to BBBSA my entire right, title and interest, if any, in and to the Released Materials and all copyrights in the Released Materials arising in any jurisdiction throughout the world, including the right to register and sue to enforce such copyrights against infringers.

I acknowledge and agree that I have no right to review or approve the Released Materials before they are used by BBBSA and/or its affiliates, and that BBBSA has no liability to me for any editing or alteration of the Released Materials or for any distortion or other effects resulting from BBBSA’s and/or its affiliates’ editing, alteration or use of the Released Materials. BBBSA has no obligation to use the Released Materials or to exercise any rights given by this Consent and Release Form.

I hereby release BBBSA and its affiliates, employees, and agents, as well as any partner companies, from all claims, demands or liabilities and related financial costs that I may now or hereafter have arising in connection with BBBSA’s exercise of the rights hereby granted, and/or with the appearance or the Released Materials in any publication or production. These include, without limitation, claims for compensation, defamation, or invasion of privacy, or other infringements or violations of personal or property rights of any sort whatsoever.

I have read this Consent and Release Form completely. I fully understand what it means, and I agree to its terms. I have not been offered any additional consideration or enticement, nor have I been coerced to sign this document. I am voluntarily signing it for the purposes and considerations described.

Volunteer Guidelines

1. I will meet with my Little weekly or bi-weekly for at least one year. I am always responsible for calling the parent/guardian to set up outings. I will not stop my regular contacts with my Little without explaining the circumstances to all parties.

2. I will be on time and will call my Little and the parent/guardian if plans need to be changed.

3. I will not make promises which I cannot keep.

4. I will not break any law while with my Little.

5. I will not use my cell phone while operating my motor vehicle with my Little in the car. Maine State Law prohibits use of handheld devices while driving. BBBS prohibits any use of a cell phone while driving with your Little in the vehicle.

6. I will immediately report any child abuse or neglect to the BBBS staff. In the event that the BBBS office is closed and I believe my Little is in immediate danger, I will call the local police.

7. I will support my Little’s relationship with their family and make no attempt to impose my values on them.

8. I understand that I will learn personal info about my Little and their family, which I will keep confidential.

9. I will be in contact with my Program Manager once a month to check-in about my match. I will respond to any communication that I receive from BBBS staff.

10. I will not engage in any type of drug or alcohol use prior to or during a match outing. I will not smoke cigarettes or use tobacco products while with my Little.

11. I understand that no overnight visits will be permitted within the first year of the match. After the first year, I will obtain permission from my Program Manager BEFORE an overnight occurs.

12. I understand that I will not visit my home with my Little for the first 3 months of our match. After 3 months I will discuss home visits with all parties and receive approval from my Program Manager.

13. I understand that match outings should generally be kept to a one-to-one basis but may occasionally include friends or family members of either myself or my Little.

14. I will maintain open communication at all times and never ask my Little to keep a secret.

15. I will respect the personal space of my Little and avoid inappropriate physical contact (e.g. backrubs, sitting in laps, tickling, wrestling, etc.).

16. I will never be physical with my Little or use verbal or emotional means of discipline.

17. I will never display or discuss any materials of a sexual nature with my Little.

18. I will provide separate areas for my Little to change clothes, bathe, and/or sleep when these actions take place during a match outing.

19. I will not communicate with my Little through social networking sites (such as Facebook, Instagram, Twitter) for the first year of my match. I will not post pictures of my Little on any profiles.

20. I will keep all firearms and ammunition secured and unavailable to my Little at my home, and I will not carry firearms in an open or concealed manner while with my Little.

I have read the above requirements, which define my responsibilities as a volunteer with Big Brothers Big Sisters. I agree to abide by them as long as I am in the program.

What is match support and why is it so important?

Big Brothers Big Sisters of Southern Maine takes great pride in creating and supporting long lasting and enduring matches. We ask that each of our matches commit to at least one year, starting the day you are matched. Most of our matches go well beyond that commitment. Our average match length is almost 3 years. Match support is what sets us apart and ensures that our matches are having fun and staying safe!

Match support is a regularly scheduled monthly check in where you discuss with your Program Manager how your match is going, and any needs/concerns you may have. Match support is also important in keeping you connected with our agency and upcoming opportunities. Match support is a non-negotiable requirement for Bigs, Littles and families when participating in our program. When the match reaches one year, the check-in schedule changes to quarterly. Of course, we are always here for support whenever you need. Quarterly check-ins are just as important as monthly check-ins, so it is vital that these are completed in a timely manner.

All parties must adhere to the match support schedule, if one part of the match does not respond to a request for check-in, the match will be at risk of closure. Parent/Guardian, Little and Big must all maintain the required schedule of communication and contact for the life of the match.

It is important that you understand that failure to comply with match support will put your match at risk of closure. Our Program team works with you to find a time that fits within your schedule. Please be mindful of scheduling with your Program Manager by responding in a timely fashion when they reach out to you.

Our policy on overdue match support states that failure to comply with required check-ins will be reason for immediate closure if the check-in reaches 30 days past due. We will send you a letter reminding you that match support is overdue and that we need to hear from you. Please be sure to get back to us within the timeframe the letter states. We are not able to re-open a match after closure for failure to comply.

Match support is a critical piece of our program in ensuring child safety. It offers the opportunity for the match to gain insight and knowledge on relationship building and for all of us to celebrate the success of the match. Relationships take time and need support to flourish and grow.

By checking this box, you are acknowledging the importance of match support and agree to comply with our required check in schedule.

Client Code of Conduct

Big Brothers Big Sisters of Southern Maine (BBBSSM) adopts this Code of Conduct to define acceptable standards of behavior for Parents/Guardians, Littles, and Bigs. This will guide the building of the relationship between Big/Little, Big/Parent/Guardian and Big/Little/Parent/Guardian/BBBBSSM. There will be no exceptions to the guidelines, they will be used in determining services and when necessary to end program involvement due to disruptive and/or unacceptable behavior. BBBSSM is committed and responsible for providing all participants with a rewarding and safe environment. Therefore, it is expected that all participants will:

1. Treat staff, families, volunteers and other participants with respect and honesty.

2. Refrain from discriminatory comments or actions and any other behavior that is derogatory to another person in our programs.

3. Inform staff of needs and changes in circumstances to receive relevant services.

4. Understand that BBBSSM works with multiple individuals with many levels of need, and staff may prioritize their time to deal with emergency or high need situations.

5. Maintain confidentiality of other clients, volunteers, and staff.

6. Client will understand that BBBSSM and its staff have limitations to the services they provide. When possible, we will share referral sources for other services.

7. Realize that access to services may have limits and eligibility does not automatically ensure services.

8. Deal with concerns and/or problems according to BBBSSM policies and procedures.

Refusal of Service:

Participants have a responsibility to be respectful and considerate of all participants and staff at BBBSSM. The decision to refuse, suspend or terminate services is made by the Program Director in consultation with the Executive Director. Wherever possible, when services are refused, BBBSSM staff will provide other community resources.

Reasons for refusal, suspension, or termination of services:

1. When the Executive Director, Program Director and program staff agree the client/participant has not followed the above code of conduct.

2. When a participant does not adhere to or follow the Program policies and procedures.

3. When a participant is/perceived to be threating, harmful, or inappropriate to fellow participants or staff.

4. When a participant behaves violently in any real or perceived manner.

5. When a participant is/perceived to be threatening or obscene in interactions with staff or other program participants.

By checking this box, I confirm that I have reviewed the above information and agree to adhere by the BBBSSM Client Code of Conduct for the duration of my involvement with the agency.

Match Guidelines, Assumption of Risk and
Release of Liability Relating to Covid-19

Thank you for your commitment to Big Brothers Big Sisters of Southern Maine. Our top priority is the health and safety of our Littles, volunteers, families, and staff. We will continue to monitor developments regarding Covid-19 and adhere to federal, state, and local guidelines to help protect all BBBS program participants and staff.

BBBS of Southern Maine provides the following guidance to our Bigs, Littles, and parents/guardians regarding safe contact for our matches. We ask each match participant to review and confirm your agreement to follow these guidelines by signing below. As always, please contact your BBBS staff with any questions, concerns, or for support in keeping connected.

Communicating about Covid-19 Risk Factors and Deciding to Meet

· In-person outings remain at the discretion of each match and its participants and are not required at this time. Matches not meeting in-person agree to maintain regular communication via virtual, phone and/or written means.

· Each person in the match must assess their health before every in-person outing. Please be open and honest about illness symptoms to protect one another and make the best-informed decision about meeting. Matches should not meet if either party has any of the following symptoms:

· fever, cough, shortness of breath

· chills, muscle pain, headache

· sore throat, congestion, loss of taste or smell, or

· nausea, vomiting, diarrhea

· In-person meetings shall not take place if a Big, Little or another member in either household is diagnosed with Covid-19, or has been exposed to Covid-19.

· If any match party has been diagnosed with Covid-19 or had symptoms, the match should not meet for at least:

· 10 days after symptoms first appeared and

· 24 hours with no fever without the use of fever-reducing medications and

· Other symptoms are improving

· Or a negative Covid-19 test has occurred no sooner than 3 days after exposure

· Fully vaccinated people who have come into close contact with someone with COVID-19 should be tested 5-7 days following the date of their exposure and wear a mask in public indoor settings for 14 days or until they receive a negative test result. They should isolate if they test positive.

· Please visit the CDC website at https://www.cdc.gov/coronavirus/2019-ncov/index.html for further guidance on what to do if you are sick, or have been exposed or think you may have been exposed to COVID-19.

Choosing Activities/Outing Locations

If match parties agree to meeting in-person:

Outings should occur in locations that allow for social distancing.
Bigs and Littles should avoid crowded places and gatherings.
Regardless of the Little’s age, each outing and activity must be approved by the Parent/ Guardian ahead of time.

Transportation:

BBBS recommends that match participants wear masks when traveling in a vehicle.

· Bigs should take reasonable steps to disinfect surfaces before and after transporting (cleaning handles, seatbelts, etc.).

· When possible, Bigs should limit transportation to short distances.

· Littles should sit in the back seat of the car, regardless of age, to provide more distance.

Protective Measures:

The following protective measures are recommended prior to and during each in-person visit:

· Make sure to wash your hands thoroughly before and after the visit. Washing hands and/or sanitizing regularly during outings is encouraged.

· Anyone participating in the visit should adhere to social distancing guidelines

· Refrain from any physical contact, including high fiving, hand holding, hand shaking, or hugging.

· Bigs and Littles should wear masks that cover their mouth and nose during the duration of the outing.

By signing below, I confirm that I have read the agency’s Covid-19 match contact requirements and that I agree to adhere to these requirements. I understand we are not obligated to have in-person contact with our match, and that we are voluntarily choosing to connect in person. I will make decisions based on what is best for the safety, health, and wellness of each person in our match and our families. I realize that despite the safety precautions outlined in this agreement, there remains a risk that I or a member of my family could become infected with Covid -19 through inadvertent contact with an infected person during a visit. I agree to assume this risk and, hereby release and hold Big Brothers Big Sisters of Southern Maine harmless from any injury, illness or loss of life that may be related to such contact.

I hereby release, covenant not to sue, discharge, and hold harmless BBBS of Southern Maine, its employees, agents, board members, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of BBBS of Southern Maine, its employees, agents, and representatives, whether a Covid-19 infection occurs before, during, or after participation in any BBBS of Southern Maine program.

Application Acknowledgement

I understand that this is an application for a volunteer opportunity and is not a promise or commitment by Big Brothers Big Sisters.

I certify that all information I have provided or will provide to Big Brothers Big Sisters, including this application, is true, accurate, and complete to the best of my knowledge. I certify that I have and will answer all questions to the best of my ability and that I have not and will not withhold any information that would affect my application for a volunteer position. I understand that information contained in my application will be verified by Big Brothers Big Sisters. I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant or my termination as a volunteer.

At any time while involved with the Big Brothers Big Sisters program, I agree to immediately inform my Big Brothers Big Sisters contact person of any and all infractions, violations, charges, and convictions related to any civil, domestic, or criminal matters. I understand that BBBS staff needs to be fully informed to provide the best guidance or support possible.

I have answered these questions honestly and completely to the best of my knowledge. By clicking "Review and Sign" I am authorizing Big Brothers Big Sisters of Southern Maine to use my e-signature provided on the following page as consent to all previously checked consent/authorization boxes on this application.

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Contact Information

YOUTH APPLICATION

BBBS of Southern Maine Volunteer Application

Criteria Required to be Accepted as a High School big

The Reasons for the Criteria

References and Background Check

Reference Information

Pre-Interview Questionnaire

Pre-Interview Questionnaire

Activity Interest Form

High School Volunteer Consent Form

Confidentiality and Release of Informationto be read and signed by all Agency Volunteers

Permission to Participate In Media & Publicity Efforts:

Confidentiality and Digital Platform Policies

Media Consent and Release

Volunteer Guidelines

What is match support and why is it so important?

Application Acknowledgement

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Confidentiality and Release of Information
to be read and signed by all Agency Volunteers

Before clicking Review and Sign, please save your progress or the application could be lost.