Go Girls Registration Form

Child's Information

Child's Name(Required)








MM slash DD slash YYYY

Family Address(Required)












Parent/Guardian's Full Name(Required)







Relation to Child(Required)




I am the parent/guardian of the child for whom I am making this application(Required)


Does your child have any medical or behavioral needs that we should be aware of?(Required)
We realize that this information can be of a sensitive nature and it will be treated with confidence and respect


Does your child have any food allergies or restrictions?(Required)


Media Consent

I allow Big Brothers Big Sisters of Dufferin and District the use of any photos of my child taken during Go Girls! as authorized by the BBBSDD Board of Directors. I give my permission for this media to be used by BBBSDD for purposes of promotional materials including newsletters, the BBBSDD website, and social media. Photographs or video productions may also be shared with community and school partners for program promotion and continued funding.(Required)


Informed Consent

I hereby give permission to Big Brothers Big Sisters of Dufferin & District 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), I understand that all efforts will be made to select a responsible Mentor who will facilitate the group program. 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 Dufferin & District, 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 Dufferin & District. I also agree that my child will participate in the Pre- Match Training Program administered by the Agency and the Upper Grand District School Board.(Required)

Optional Section: Statistical Information

At Big Brothers Big Sisters of Dufferin and District, statistical information is requested from volunteers and families for the purpose of better understanding the community in which we serve, and for acquiring funding from community supporters and donors. This allows us to provide culturally responsive and high-quality services at no cost.

Filling out this section is optional. If you choose to complete it, the information you provide below will be kept confidential and will in no way affect your child’s eligibility to participate in our program(s).

Child's Birth Place