Big Brothers Big Sisters - Enroll a Child

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Child Application

* indicates required field

*Parent/Guardian Name:

*Parent/Guardian Address:

Address 2:

*Parent/Guardian City:

Parent/Guardian County:

*Parent/Guardian State:

*Parent/Guardian Zip

*Parent/Guardian Home Phone:

Parent/Guardian Email:

Parent/Guardian Work Phone:

*Childs Name:

*Gender:

Boy Girl

*DOB:

(mm/dd/yyyy)

*Child's School:

*Grade:

*We have a special program for children with a parent in prison or jail. Would this program apply to your child? No Yes

Does this child have other siblings who could benefit from having a Big Brother/Big Sister?

Child's Name	Age	Gender
		Boy Girl
		Boy Girl
		Boy Girl
		Boy Girl

*What is the Primary Reason for you wanting this child to have a Big Brother/Big Sister?

Your Contact Information

Same As Above:

*Your Name:

*Your Phone #:

*Your Email:

*Relationship to the child:

*How did you hear about us?

By submitting this online form, I agree to the following.

I understand that this application constitutes a request to Big Brothers Big Sisters of Metro Milwaukee to involve my child in their program. I further understand that both my child and I will have the opportuntity of learning about a potential volunteer before an assignment is made and that we will have the option not to accept the volunteer selected by the agency. In seeking a volunteer for my child, I agree to allow my child to accompany the volunteer selected by the agency to go on Big Brothers Big Sisters outings when they are scheduled. I understand that neither the agency nor the volunteer(s) assumes legal or financial liability.