LITTLE ENROLMENT FORM
 
 
 
This is the enrolment form for your child/youth. If you are enrolling more than one child, please complete a separate form for each child.

This enrolment form is for families residing in Toronto ONLY (i.e., an M postal code). If you do not reside in Toronto, please email enrolment.to@bigbrothersbigsisters.ca and we can direct you to the appropriate agency. 

Your child/youth must be between the ages of 7-15 to participate in our 1:1 programs. 

If you have any questions, please contact enrolment.to@bigbrothersbigsisters.ca
 
 
Section A: Application Details
 
A01. I am applying on behalf of my child to become a Mentee.*
 
 
 
A02. Application Received*
 
 
 
 
 
A03. Which program are you interested in for your child?*
 
 
A04. How did you hear about us? (i.e. word of mouth, always known, referred by an organization - if you are referred from an organization, please provide which organization you were referred from)*
 
 
If your child is part of the 2SLGBTQIA+ community, select program "Big Sibling" 
 
Section B: Child/Youth Information
 
B01. First Name*
 
 
B02. Middle Name
 
 
B03. Last Name*
 
 
B04. Chosen Name
 
 
B05. Preferred Pronoun (ex. he/him, she/her, they/them)*
 
 
B06. Mobile Phone
 
 
B07. Home Phone
 
 
B08. Email (caregiver if child does not have an email)*
 
 
B09. Street*
 
 
B10. City*
 
 
B11. Postal Code*
 
 
 
 
Must reside in Toronto (i.e., have an “M” postal code) 
B12. Province / Territory*
 
 
B13. Country *
 
 
 
B14. District Area*
 
 
MNC - North York, MNE - North Scarborough, MNW - Rexdale, MSC - Downtown, MSE - South Scarborough, MSW - Etobicoke
Check this map if you are unsure where you are in our District Areas: CLICK HERE for map 
 
 
 
B15. Date of Birth*
 
 
B16. What's your gender identity?*
 
 
B17. Gender: Self-Identify
 
 
Must be between ages 7-15 
 
 
B18. Born in Canada?*
 
 
B19. Current status in Canada. Please select one:*
 
 
B20. Date of Arrival in Canada
 
 
B21. Tell us about your ethnic origin(s). Please select the one that best applies:*
 
 
 
B22. Does your child identify as a member of any of the following communities? Please select one*
 
 
B23. Other:
 
 
*Person of Colour (POC) refers to anyone who identifies as: South Asian, East Asian, Southeast Asian, Arab/West Asian, Latin/Central/South American  
B24. Preferred Language of Communication
 
 
B25. Additional Languages Spoken
 
 
B26. Name of School*
 
 
 
If your child's school is not listed in the drop down menus, please select "other" (at the end of the list) and enter their school name in the corresponding box. 
 
 
 
B26. If your child's school is not listed, please enter here:
 
 
 
B27. Teacher Name
 
 
B28. Grade (enter number)
 
 
 
Section C: Child/Youth Needs

In order to meet your child’s needs best, please indicate if your child has been supported for or is affected by any of the following:

 
C01. Living in Subsidized Housing
 
 
C02. Learning or Literacy Issues
 
 
C03. Chronic Physical Illness
 
 
C04. Mental Health Issues
 
 
C05. Violence or Abuse
 
 
C06. Alcohol or Drug Abuse
 
 
C07. Please tell us anything else you think we should know:
 
 
 
 
Section D: Child/Youth Medical Information
 
D01. Emergency Contact Name*
 
 
D02. Emergency Contact Relationship*
 
 
(Other than primary caregiver contact)
 
D03. Emergency Contact Mobile*
 
 
D04. Child Health Card #
 
 
D05. Does your child have any allergies or dietary restrictions?
 
 
 
D06. Does your child have any medical needs or conditions? If yes, please explain:
 
 
 
Section E: Referral Contact Information (if applicable)
 
E01. Referral Source
 
 
E02. Referring Worker
 
 
E03. Referring Worker Email
 
 
E04. Other Professionals Involved
 
Yes
No
 
E05. Other Referral Sources
 
 
 
Section F: Primary Caregiver Information
 
F01. Name of Parent/Caregiver*
 
 
F02. Primary Caregiver Email *
 
 
F03. Alternate E-mail
 
 
F04. Relationship to Child*
 
 
F05. Relationship Extra Info
 
 
F06. Lives with child?*
 
Yes
No
 
F07. Mobile Phone*
 
 
F08. Home Phone
 
 
F09. Business Phone
 
 
F10. Primary Caregiver Street 1
 
 
F11. Primary Caregiver Street 2
 
 
F12. Primary Caregiver Street 3
 
 
F13. City
 
 
F14. Province / Territory
 
 
 
F15. Postal Code
 
 
F16. Country
 
 
 
F17. District Area
 
 
MNC - North York, MNE - North Scarborough, MNW - Rexdale, MSC - Downtown, MSE - South Scarborough, MSW - Etobicoke
 
Section G: Other Caregiver Information (if applicable)
 
G01. Other Caregiver Name
 
 
G02. Other Caregiver Email
 
 
 
G03. Relationship to Child
 
 
G04. Relationship Extra Info
 
 
G05. Lives with child?
 
Yes
No
 
G06. Mobile Phone
 
 
G07. Home Phone
 
 
 
G08. Other Caregiver Street 1
 
 
G09. Other Caregiver Street 2
 
 
 
G10. City
 
 
G11. Province / Territory
 
 
 
G12. Postal Code
 
 
G13. Country
 
 
 
 
Section H: Family & Household Information
 
H01. Who does the child live with primarily?*
 
 
 
H02. How many siblings does the child have?*
 
 
H03. Family Access to Vehicle?*
 
Yes
No
 
H04. Only respond to this question if the child is living under the care of any welfare agencies (ex. Children's Aid Society, Catholic Children's Aid Society, Native Child and Family Services, Jewish Family and Child Services). What best describes their situation?
 
 
 
H05. Only respond to this question if the child's parents are separated or divorced. What best describes the custody of the child?
 
 
 
H06. If there is shared custody: do you have permission from non-custodial parent to register child? (note: consent must be granted by both parents/guardians with custody in order to enroll)
 
 
 
 
 
Our Mentees are occasionally invited to apply for camps or post-secondary scholarships, in order to be eligible for such opportunities, please indicate your Household Income: 
 
 
 
H07. Household Income
 
 
H08. Income Source
 
 
 
 
Section I: Match Critera
 
 
 
What are your child/youth's interests? Select all that apply. 
I01. Animals
 
 
I02. Arts & Crafts
 
 
I03. Computers
 
 
I04. Building (e.g. Lego)
 
 
I05. Cooking
 
 
I06. Cultural Activities
 
 
I07. Board Games / Cards
 
 
I08. Educational Activities
 
 
I09. Dance
 
 
I10. Movies / TV
 
 
I11. Indoor Activities
 
 
I12. Festivals and Local Events
 
 
I13. Music
 
 
I14. Outdoor Activities
 
 
I15. Reading / Books
 
 
I16. Sports
 
 
I17. Talking
 
 
I18. Video Games
 
 
 
 
 
When is your child available to meet with a mentor? 
I19. During the School Day
 
 
I20. After School
 
 
I21. Weekday Evenings
 
 
I22. Weekends
 
 
 
 
 
 
How would you describe your child? Select all that apply. 
I23. Friendly
 
 
I24. Quiet
 
 
I25. Highly Active
 
 
I26. Withdrawn
 
 
I27. Helpful
 
 
 
Please select one or both that best describes your child: 
I28. Extrovert (Outgoing)
 
 
I29. Introvert (Shy)
 
 
 
How is your child/youth around animals? 
I30. Do you have pets?
 
 
I31. Is your child comfortable around animals?
 
 
 
Section J: Additional information
 
J01: Is there anything else you would like to share with us?
 
 
 
 
Application Submission
 
 
 
Big Brothers Big Sisters agencies in Canada use a centralized online case file system. If your child has been involved in the past with another Big Brothers Big Sisters agency in Canada, the information you submit in this form will be transmitted and shared with both the agency you are applying to, along with the agency your child was previously involved with. If you do not want your child's information shared with the previous agency you had contact with, please contact enrolment.to@bigbrothersbigsisters.ca. 
 
 
 
A05. Date of Application*
 
 
 
 
 
 
 
Please slide the bar below to unlock the form before submitting 
 
 
 
 
 
IMPORTANT NOTE: If you are not directed to a 'thank you for submission' page, there is missing information on the form. Please go back through the form and look for a note in red that says "This field is required. Please enter a value."