This field is hidden when viewing the form
As an existing participant in the mentoring program administered by Big Brothers Big Sisters of London and Area, hereby provide my consent to engage in mentoring services. I understand that the Agency’s goal is to support meaningful mentoring relationships between adult participants and responsible Mentors (minimum age 18; younger volunteers may be considered under appropriate supervision). I consent to the continued collection, use, and disclosure of my personal information by Big Brothers Big Sisters of London and Area for the purpose of administering the mentoring program. This includes: • Sharing relevant information with Big Brothers Big Sisters of Canada and their insurers, as may be required in connection with legal proceedings, inquiries, or risk management. • Contacting referring professionals involved in my care or support to obtain updated information that may assist in evaluating or enhancing my mentoring experience. • Discretionary sharing of relevant information with my Mentor and/or referring professionals to ensure my needs are appropriately addressed within the mentoring relationship. I understand that all personal information will be held in strict confidence and used solely for program-related purposes. I acknowledge that participation in the mentoring program is voluntary. I am under no obligation to continue with a Mentor, and the Agency is under no obligation to assign or maintain a Mentor for me. I understand that this consent form and any related documentation remain the property of Big Brothers Big Sisters of London and Area. I agree to participate in any ongoing or updated training programs as required by the Agency to support the success of my mentoring relationship. I HAVE READ AND UNDERSTAND THIS AGREEMENT. BY SIGNING BELOW, I ACKNOWLEDGE THAT: I consent to the continued provision of mentoring services through Big Brothers Big Sisters of London and Area. I understand the risks, responsibilities, and benefits associated with this service and agree that it remains suitable for me.
As an existing participant in the mentoring program administered by Big Brothers Big Sisters of London and Area, hereby provide my consent to engage in mentoring services. I understand that the Agency’s goal is to support meaningful mentoring relationships between adult participants and responsible Mentors (minimum age 18; younger volunteers may be considered under appropriate supervision).
I consent to the continued collection, use, and disclosure of my personal information by Big Brothers Big Sisters of London and Area for the purpose of administering the mentoring program. This includes: • Sharing relevant information with Big Brothers Big Sisters of Canada and their insurers, as may be required in connection with legal proceedings, inquiries, or risk management. • Contacting referring professionals involved in my care or support to obtain updated information that may assist in evaluating or enhancing my mentoring experience. • Discretionary sharing of relevant information with my Mentor and/or referring professionals to ensure my needs are appropriately addressed within the mentoring relationship.
I understand that all personal information will be held in strict confidence and used solely for program-related purposes.
I acknowledge that participation in the mentoring program is voluntary. I am under no obligation to continue with a Mentor, and the Agency is under no obligation to assign or maintain a Mentor for me. I understand that this consent form and any related documentation remain the property of Big Brothers Big Sisters of London and Area.
I agree to participate in any ongoing or updated training programs as required by the Agency to support the success of my mentoring relationship.
I HAVE READ AND UNDERSTAND THIS AGREEMENT. BY SIGNING BELOW, I ACKNOWLEDGE THAT: I consent to the continued provision of mentoring services through Big Brothers Big Sisters of London and Area. I understand the risks, responsibilities, and benefits associated with this service and agree that it remains suitable for me.
Name
MM slash DD slash YYYY
Clear Signature