B - CAREGIVER(S) INFORMATION
bd-Relationship to Child*
be-Do you have any other children involved with this agency? (Matched, Waiting List, In School Mentoring/Go Girls!/Game On! Program?*
bf-If yes, please list their names:
bj-Relationship to Child*
C - PROFESSIONAL INVOLVEMENT
ca-Have any of the following school services been involved with your child?
cb-If yes, please state the details (names, dates, etc.):
cc-Are there social service agencies involved with your family? (i.e. - Hospitals, Children's Aid Society, Youth Services Bureau, etc.)
cd-If yes, please state details: (names, dates, etc.) With your consent Big Brothers Big Sisters Ottawa would like to contact the community agencies involved with your child.
ce-Name and address of agency
cf-Contact Person and Telephone Number
D - MALE INVOLVEMENT (to be completed for Little Brother applicants only)
db-Does the Father have visiting rights?
de-If "Yes" how often does he exercise this right?
df-How old was your son when separation/death occurred?
dg-What is your son's reaction to the absence of his father?
dh-Is there presently male involvement with the family, i.e. uncle, grandfather, boyfriend?
di-If yes, please identify his relationship to you:
dj-Please indicate the frequency of contacts: