High-Risk Activity Permission Form - Big Brothers Big Sisters of London and Area

I,

I

the parent/guardian of

give permission for my child to participate in the following high-risk activity with their mentor:

Age of child(Required)

Activity(Required)

Date of activity(Required)

Time of activity(Required)

Location of activity(Required)

Will qualified personnel be present (lifeguard, etc)(Required)

The following safety equipment and precautions will be in place:(Required)

Date(Required)

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Matches may request to engage in a Permitted High-Risk Activity and submit this permission form directly to their Mentoring Coordinator each and every time they wish to engage in this activity. Matches must receive permission from their Mentoring Coordinator to engage in the above activity. Please submit the form a minimum of two business days before the day of the activity to allow time for the request to be reviewed. Approval for the match to engage in a High-Risk Activity is at the discretion of the agency.

SMS Verification(Required)

By clicking Submit, I consent to the collection of this personal information in accordance with Big Brothers Big Sisters of London and Area's Privacy and Confidentiality Policy.