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Mentee Online Application
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Please ensure all required fields are completed in order to submit the application.
If there is an error or missing information you will not be able to submit the form.
Errors will be identified by red text or asterix.
Once the fields are completed use the slider at the bottom to unlock the form for submission. You will receive a confirmation message once the application has been submitted.
If you have any questions or issues completing the form please contact our Program Director, Jessica Munn, jessica.munn@bigbrothersbigsisters.ca or 506-305-0089.
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Youth / Participant Information
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- Child's First Name:
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Child's Last name*
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Chosen Name
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- Gender
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Preferred Pronouns
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Date of Birth (DD/MM/YYYY)*
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Preferred Language of Communication
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Additional Languages Spoken
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Is your child aware of your application for a Big Brother Big Sister?
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Client
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Parent / Guardian Information
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For the purpose of this application, the term primary parent / guardian refers to the primary point of contact for any program-related communication.
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- Primary Parent/Caregiver's Name:
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If Guardian, please note relationship to child:
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- Parent/Caregiver's Home Phone:
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Primary Caregiver Mobile Phone
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Primary Caregiver Business Phone
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- Primary Parent/Caregiver's Email:
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If you are a single parent with custody, what are the visiting rights of the other parent?
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- Other Parent/Caregiver's Name:
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- Other Parent/Caregiver's Email:
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Other Caregiver Home Phone
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Other Caregiver Mobile Phone
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Other Caregiver Business Phone
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What type of Relationship does your child have with the other parent?
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Is the other parent aware of your application for the program?
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Address
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Address (Include Apartment/Unit #)*
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Address: City*
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Address: Province
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Address: Postal Code*
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PO Box or RR (If Applicable)
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Address 1: Country/R
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Siblings
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Does the child have any siblings currently involved in our programs? EDM
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- Please provide the Names and Ages of your child's siblings:
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School Information
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Client - School
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Grade
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- Teacher's Name:
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Other Agencies
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Are you or your child involved with any other community agency?
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Agency Name:
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Are there currently any services/workers supporting you or your child? If yes, please detail:
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Does anything prevent your child from fully participating in the program?
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Emergency Contact & Medical Information
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Emergency Contact Name*
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Emergency Phone 1*
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Emergency Phone 2
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Emergency Contact Relationship
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Health Card #
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- Child's health details (General, Medications, Diagnoses, Mental Health, Special Considerations):
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Demographic Information
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Big Brothers Big Sisters of Greater Moncton is asking all applicants to help us learn more about the diversity of our volunteers, youth and communities.
We encourage everyone to self identify where they feel comfortable, but it is not required. This information will help us to understand who our volunteers and clients are, how demographics are changing, and how best to support everyone in being successful in our programs or to ensure programs continue to remain relevant and impactful.
Thank you in advance and if you have any questions please don't hesitate to contact us.
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Child was born in Canada
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Newcomer Status
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If not born in Canada, when did you arrive?
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Child's Ethnic Identity
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Confidentiality
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Just as we have to share information with you about the Mentor we select for your child, we need to share information with the volunteer about you and your child.
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Is there anything here that you do not want shared with a volunteer?
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Additional Information
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The answers you have given will help us to do our best for your child. Please be sure to advise us of any changes in your home situation, such as address changes, relationship changes, etc.
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Is there anything else you would like us to consider?
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Please use the slider and enter today's date to confirm you are a person (or otherwise sentient life form).
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Please enter today's date!*
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For Office Use
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Application Received On-Line
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Application Received
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