BIG BROTHERS BIG SISTERS

of Snohomish County

1420 Hewitt Ave Everett, 98201 Phone: (425)252-2227 Fax: (425)259-2487 Just the Facts The best way to change the world is one life at a time. Becoming a Big Brother, Big Sister or Big Couples Match is the best way you can help the worldone child at a time. Volunteers with our program are taking that opportunity. To share. To care. And to guide a child down the right path, when he or she may not be sure which way to turn. What children are referred to Big Brothers Big Sisters? Children in the program come from every community in our county. They are between the ages of 6 and 14. What is a Big Brother or Big Sister? The role of a Big Brother or Big Sister is to be a special friend and to provide caring, role modeling, and mentoring to one boy or girl in our program. Who can be a Big Brother or Big Sister? To become a Big Brother or Big Sister with our agency, an individual must be at least 18 years of age, have a valid drivers license, an insured vehicle, and pass a criminal background check. Additionally, we accept individuals who are stable, dependable, and can provide positive role modeling. Couples can also apply to become a Couples Match to one of our waiting Little Brothers. What is the time commitment? Our Big Brothers, Big Sisters, and Big Couples see their Little Brothers and Sisters 2-4 times a month for 2-4 hours per outing. Our agency requires a commitment of at least six months, and encourages continuation beyond this minimum commitment. The friendships we create are on-going. Officially, we can support a match until the child graduates from high school or turns 18. Ideally, we create relationships that will last a lifetime. Who pays for this service? There is no charge to the children or families who receive services from our agency. United Way provides approximately a third of our operating budget. The remainder of our budget comes from individual fund raising events such as Bowl For Kids Sake, our annual Dreambuilders Auction, individual donations, and grants from local foundations and businesses. How many kids do you serve? Big Brothers Big Sisters of Snohomish County provides a variety of services to approximately 610 children annually. Our core Match Program currently serves approximately 450 children annually and includes Big/Little Brother Matches, Big/Little Sister Matches, Couple/Little Matches, and Cross-Gender Big Sister/Little Brother Matches. Our School-Based Mentoring Program matches children with volunteers at the school site. Additional services include activities for children (both matched and on the waiting list), Back to School Packs, Holiday Giving, Volunteer Training, and Referrals. The best time is now. We currently have nearly 100 terrific kids waiting for their Big Brother or Sister. If youve ever considered becoming a Big Brother or Sister, the best time is now. The need is great, and so are the awards. Call (425) 2522227 and find out how you can take the next step.

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VOLUNTEER APPLICATION
Big Brothers Big Sisters of Snohomish County
A branch of the YMCA of Snohomish County
Big Brothers Big Sisters of Snohomish County creates quality one-to-one mentoring relationships which will help children to achieve their highest potential.

1420 Hewitt Avenue Everett, 98201 (425)252-2227 Fax (425)259-2487

Big Brother/Big Sister Applying for: (Please check one) Community-Based Mentor
First Name: Nicole Home Address: 6228 171st St S.W. Zip Code: 98037 Home Phone: Female Male Work Address: Occupation: May We Contact You At Work: Yes No Work Hours: City: Ethnicity: State: Zip: Social Security #: County: Email: Work Phone: Employer: Cell Phone:

or School-Based Mentor
Middle Name: Beatriz

Last Name: Sanchez City: Lynnwood

Date of Birth: 09/25/1983 State: WA

Religious preference: How Long Employed:

Have you lived in Washington State for the last 3 years? Yes No If you have not lived in Washington for the past 3 years, please provide your addresses for the last 3 years. Dates:________________ Address:_________________________________________________________ Dates:________________ Address:_________________________________________________________ Do you have a drivers license? Yes No If yes, state of issue and #: Expiration date:

Have you ever applied before (or have been) to be Where and When: a Big Brother or Big Sister? Yes No What, if any, other youth organizations have you worked for or been involved with as a volunteer?

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Have you been convicted of any criminal offense (other than a juvenile offense which has been expunged from your record) or released from prison. Yes No If yes, describe in full. (Only convictions that the YMCA/BBBS believes are reasonably related to the duties of the job will be considered.)

REFERENCES 1. Employer or School (If in High

School Bigs program it must be school):

Supervisors Name or Teacher/Counselor:

(Current of past Supervisor/Teacher/Counselor who has known you for at least 1 year)

Address: Day Phone #: Fax #:

City:

State: Email (preferred):

Zip:

2. Coworker or Previous Volunteer Organization who has known you for at least 2 years: Address: Day Phone #: Fax #: City: State: Email (preferred): Zip:

3. Relative/Domestic Partner/Friend who has known you for at least 3 years: Address: Day Phone #: Fax #: City: State: Email (preferred): Zip:

Participation and Release

Mission: The YMCA of Snohomish County promotes the values of caring, honesty, respect, and responsibility through programs that build strong kids, strong families, strong communities. I agree to cooperate in the fulfillment of the mission. Certification: I certify that the information contained in this application form is true, correct and complete to the best of my knowledge. I authorize the YMCA/BBBS to make inquiries regarding my education, work experience, references and a criminal background check. I release all parties and persons associated with any such inquiries from liability in connection with information they give.

Volunteer Terms: I agree to abide by the rules and regulations of the YMCA/BBBS and understand that my services are donated to the YMCA/BBBS without contemplation of compensation. The YMCA/BBBS does not provide insurance and related benefits to volunteers. As an example, there are no insurance plans for volunteers, including no medical, accident, dental, workers compensation, disability, or other coverage. The YMCA/BBBS does not offer free memberships to volunteers. Volunteers may not trade their time for free or reduced cost program participation.

Photograph Permission: I give permission for the YMCA/BBBS to use, without limitation or obligation, photographs, film footage or tape recordings which may include my image or voice for purposes of promoting or interpreting YMCA/BBBS programs. Medical Treatment: I give permission for YMCA/BBBS staff or volunteers to provide emergency medical treatment, and to transport to an emergency center for treatment. Also, I consent to medical treatment deemed immediately necessary or advisable by a physician. Release of Liability/Participation: I am an adult age 18 or older or in High School Bigs program and wish to participate in YMCA activities. In addition, if applicable, I give permission for my dependents to participate in YMCA/BBBS activities. I understand that accidents can sometimes happen. Therefore, in exchange for the YMCA/BBBS allowing me, and if applicable, my spouse and my dependents to participate in YMCA/BBBS activities, I understand and expressly acknowledge that I release the YMCA/BBBS, its employees, its boards, members, volunteers or guests from all liability for any injury, loss or damage connected in any way whatsoever to participation in YMCA/BBBS activities whether on or off the YMCAs/BBBS premises and including transportation. I understand that this release includes any claims based on negligence, action or inaction of the YMCA, its employees, boards, members, volunteers or guests.

Limits of Confidentiality: The undersigned acknowledges and agrees that any normal limits on confidentiality do not apply in the case of negligence, instances of physical or sexual abuse, or if applicant is deemed to be a danger to himself/herself/or others, and that such information as the agency may have in these matters can be used in civil or criminal proceedings. I am in no ways obligated to perform any volunteer services;

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 The BBBS agency is not obligated to match you with a youth; As part of our enrollment processes, we will be asking you to provide additional personal information prior to make any recommendations for assignment.

____________________________________________

Signature

_________________________ Date

_______________________________________________ ___________________________ Parent/Guardian Signature (only if in High School Bigs program) Date Big Brother/Big Sister Application Page 3

Interest Checklist
Name Like it Baseball / Softball Soccer Basketball Football Jogging Racquetball Tennis Badminton Skateboarding Volleyball Bike Riding Snow Boarding Snow Skiing Water Skiing Boating / Canoeing Swimming Fishing Gardening Hiking Camping Hunting Horseback Riding Golfing
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Date Would Try Dont Like Roller Skating Ping Pong Working on Cars Motorcycles Frisbee Crafts Woodworking Drawing Sewing Baking /Cooking Shopping Movies Animals Drama / Theater Talking Restaurants Museums Board Games Computers Video Games Singing/Dancing Garage Sales Reading
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Like It

Would Try

Dont Like

Gymnastics Bowling Ice Skating

Going to Parks Music__________ Other__________

Big Brothers Big Sisters Office

(North)

1420 Hewitt Avenue, Everett, WA 98201 (425) 252-BBBS From the North Going South on I-5 take the Everett Ave exit 194 to Everett Ave/City Center Take a left on Broadway Take a right on Hewitt Avenue Office is just past Hoyt on left side (Next to Yummy Teriyaki) From the South Going North on I-5 take Broadway exit (on the right) Take a left on Hewitt Ave. Office is just past Hoyt on left side (Next to Yummy Teriyaki)

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