Step 1 of 2

Enroll Your Child – There's only 2 steps

Child's Information

I am Interested in the following program for the child: No Preference — You can choose later. Community-Based Program — what's this? School-Based Program — what's this? Site-Based Program — what's this? Mentoring Children of Prisoners Program — what's this?
•Child's First Name:	•Child's Last Name:
•Child's Gender: MaleFemale	•Child's Date of Birth (## / ## / ####):
•Ethnicity/Race:

Check here if you are NOT the child's legal guardian.

Your Contact Information
Please fill out the following section if you are not the child's legal guardian

Your First Name:	Your Last Name:
Your Relationship to the Child:	•Email:
Best Phone # to Contact You at:	Phone #:

Parent / Guardian's Contact Information

•First Name:	•Last Name:
Relationship to the Child:	•Email:
Address:	Apt. #:
City:	State:	•Zip:
At least 1 phone # is required; Home, Cell or Work.
Home Phone:	Cell Phone:
Work Phone:	How did you hear about Big Brothers Big Sisters?:
Preferred Phone: Home Work Cell	Best Time to Call: Morning Noon Night

Check here if the child does NOT live at the address above.

Emergency Contact — (Other than Parent) Required

Check here if the child has a parent in prison.