Consent for Minor to Participate in Outreach for
Big Brothers Big Sisters of Greater Rochester

Once completed, fax this form to 585-442-2428 or mail to:

Big Brothers Big Sisters of Greater Rochester
232 South Plymouth Ave.
Rochester, New York 14608
Attn: Outreach
If you have any questions, call 877-877-4057 and ask to speak to an Outreach Specialist.

One very positive trend and indicator in our society is the rate at which young people are becoming involved in important causes - as volunteers, leaders and supporters. Big Brothers Big Sisters provides a number of ways for your young person to show that he or she cares about their own future and the future of their fellow child. For example, each year, young participants in our national Bowl for Kids' Sake raise thousands of dollars to help us reach more children with a Big Brother or Big Sister.

In all matters pertaining to a minor's involvment in BBBS initiatives and activities, we place the protection of privacy, personal safety and the authority of a parent or guardian as our highest priority.

Kindly INITIAL your directives(s) below and forward this to our office. Complete a separate sheet for each participating child. The following directives apply to: ___________________________ (child's name)

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You may communicate directly with my child (child must be 16 years or older)
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Please direct all communications related to my child's volunteer service to Big Brothers Big Sisters to my attention (i.e.: "To parent or guardian of Billy Davis ").
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You may set up a Bowl for Kids' Sake web page for my child. (See http://bbbsr.org/bowling/billyd)
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You may identify my child by first name, last initial and town (Billy D. of Macedon).
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You may identify my child by first name only and provide no other identifying or geographic information.
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Please DO NOT use my child's name, identity or likeness in any BBBS matter. Any further communications are to be to me directly.

Your Name: ____________________________ Signature: ________________________
Address: ____________________________________________________
City: ____________________________ State __________ Zip __________
Phone: ____________________________
E-mail Address: _____________________________________________
(To be held in privacy and used only for purposes related directly to BBBS communications)