Little By Little in Community Program Permission Form 2025-2026
 

Agency: Big Brothers Big Sisters of Toronto (BBBST) is a non-profit agency that focuses on providing Toronto’s children and youth (Ages 12 to 16) with mentoring programs and opportunities. (https://toronto.bigbrothersbigsisters.ca)

Program: 8-12 selected participants living in TCHC buildings will be matched with two adult (18+) volunteer mentors to engage in discussions and physical activities around topics such as body image, self-esteem, social media, being active and team work. Activities include team-building games, sports and arts/crafts. All participants are provided with a snack during the program.

Outcomes: The goal of Little by Little in Community is to provide children/youth with information and support to make informed choices about active living, balanced eating, and to increase confidence and self-esteem.

Supervision: A Program Facilitator will be on-site for the duration of the program. The program will be monitored via email, phone and in-person by the BBBST Group Program Manager.

Where: On TCHC property:
Mount Olive - 53 Silverstone Dr
Trethewey - 720 Trethewey Dr
Falstaff - 30 Falstaff Ave
York Square - 2468 Eglinton Ave West

When: Mount Olive - Every Friday  from Oct 17th, 2025 to June 5th, 2026 - From 4:30pm to 5:30pm
            Trethewey - Every Tuesday from Oct 21st, 2025 to June 16th, 2026 - From 4:30pm to 5:30pm
            Falstaff - Every Wednesday from Oct 22nd, 2025 to June 10th, 2026 - From 4:30pm to 5:30pm
            York Square - Every Thursday from Oct 23rd, 2025 to June 11th, 2026 - From 4:30pm to 5:30pm

Duration: 30 session program runs once a week on the specified program day mentioned above. The program does not run during holidays. The program will end on FINAL DATE. Please be advised that any school/program cancellations will result in an additional session past this date.

Guest Workshops: Groups may have the opportunity to host a number of educational and active workshops from outside guests. These vary per group and parents/guardians will be notified when guest speakers come into the group program during program time, onsite only.

If you have any questions about the program, feel free to (contact Tara Hartley, Manager of Group Programs) at: tara.hartley@bigbrothersbigsisters.ca or 416-925-8981 ext. 4127.

 
 

PARTICIPANT INFORMATION FORM

 
Please Note: For program safety purposes we are required to ask the following questions. All information will be kept confidential.
 
First Name*
 
 
Last Name*
 
 
Date of Birth*
 
 
Age*
 
 
Grade*
 
 
 
- Gender*
 
 
- Gender Identity, if not represented:
 
 
 
School Name*
 
 
Home Address*
 
 
City*
 
 
- Postal Code*
 
 
Is this Home Address Community Housing?*
 
 
Was your child born in Canada?*
 
 
If no, when did they arrive in Canada?
 
 
What is your child’s Newcomer Status?
 
 
Does your child belong to any of the following ethnicities?*
 
 
Child’s Phone Number (if applicable)
 
 
Child’s Email*
 
 
 
 
 
 
Parent/Guardian Information
 
 
 
Parent/Guardian's Name:*
 
 
Please note relationship to child*
 
 
Parent/Guardian's Home Phone*
 
 
Parent/Guardian's Cell Phone:
 
 
Parent/Guardian’s Email:*
 
 
 
 
 
 
Emergency Contact Information
(Must be different from Parent/Guardian Information) 
 
 
 
Emergency Contact Name*
 
 
Relationship to participant*
 
 
Emergency Phone 1*
 
 
Emergency Phone 2
 
 
 
 
 
Please indicate if your child is experiencing or been affected by the following:
 
 
 
Behavioral Challenges (General)
 
 
Depression
 
 
Social Isolation/Awkwardness
 
 
Anxiety
 
 
Anger Issues
 
 
Difficulty Regulating Emotions
 
 
Academic Challenges
 
 
Learning or Literacy Issues
 
 
Self-harm/suicidal ideation
 
 
Bullying
 
 
Hyperactivity/Impulsivity
 
 
OCD/ODD/CD/ADHD
 
 
Autism
 
 
Involved with Child Welfare (CAS)
 
 
Other
 
 
*Obsessive-Compulsive Disorder/Oppositional Defiant Disorder/Conduct Disorder/Attention Deficit Hyperactivity Disorder 
 
Chronic Physical Illness
 
 
If yes, to "Chronic Physical Illness" please specify
 
 
Food Requirements
 
 
Client - Allergies
 
 
Other Medical Needs
 
 
 

*As a charity organization, we require the following information to apply for fundraising so we can continue supporting children across Toronto.*

 
Household Income
 
 
Income Source
 
 
# of Children in the Household
 
 
Who does the child live with?
 
 
 
 
 
 
Program Pick-Up Information
(Only required for elementary after-school programs)
 
 
 
 
 
 
Pick up Info*
 
 
Pick-up Authorization Person
 
 
Phone Number
 
 
Relationship to Child
 
 
 

Informed Consent Form- To Be Signed By Parent/Guardian

 
 

I hereby give permission to Big Brothers Big Sisters of Toronto 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 Toronto, 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 Toronto, 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 Toronto. I also agree that my child will participate in the Pre-Match Training Program administered by Big Brothers Big Sisters of Toronto Staff.

I (Parent/Guardian) HAVE READ AND UNDERSTAND THIS AGREEMENT.

BY SIGNING THIS AGREEMENT, I (Parent/Guardian) ACKNOWLEDGE THAT:

 
I (Parent/Guardian), the parent/guardian of (child in program) , 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 Toronto. 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.
 
(Parent/Guardian)*
 
 
(child in program)*
 
 
 

  
 
 
Signature of Parent/Guardian*
 
I consent that this document acts as my electronic signature and permission.
 
Date of Signature*
 
 
 
 
 

Media Consent Form – Child/Youth

 
 
Name of Child/Youth*
 
 
 
 
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 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.
 
 
Media Release selection*
 
 
Date of Signature*
 
 
 
 
Application Received
 
 
I am applying on behalf of my child to become a Mentee
 
 
 
BBBST Inquiry Program
 
 
Hidden Program Type (BBBST)
 
 
 

Note: It is the parent/guardian’s responsibility to notify the office if the status of this consent changes.