BIG BROTHERS BIG SISTERS OF SOUTH TEXAS
202 Baltimore San Antonio, Texas 78215
Phone (210) 225-6322, Fax (210) 225-1961


Note: A valid email address is required to use our online form. If you would prefer to print this form and fill it in by hand to FAX or mail to us, you can download it here: Word Doc  PDF.
(To view / print the PDF file, Adobe Acrobat is required. If you don't have it, download it here).

The information you give in this application will be kept confidential. It will be used by the personnel of Big Brothers and Big Sisters to help you and your child/children.

Program of interest: 
Community-based  School-based       Boys & Girls Club
Seton Home          St. PJ's Home      Transplants for Children
Date of Inquiry: Referral Source:
Referral Source (Other):
Parent's Name:
Address:  City: State: Zip:
Home Phone:         Work Phone:           Cell Phone:
E-Mail:
     
Employer:
Employer Address:  City: State: Zip:
     
Child's Name:  Age:   DOB: Gender: Male  Female
Ethnicity:

If other, please specify: 

Child's school:  Grade:
     
Child's Name:  Age:   DOB: Gender: Male  Female
Ethnicity:

If other, please specify: 

Child's school:  Grade:
     
Child's Name:  Age:   DOB: Gender: Male  Female
Ethnicity:

If other, please specify: 

Child's school:  Grade:
     
Child's Name:  Age:   DOB: Gender: Male  Female
Ethnicity:

If other, please specify: 

Child's school:  Grade:

What is the primary reason for you wanting your son/daughter to have a Big Brother / Big Sister?

Do you feel your son or daughter has any conditions that will affect him or her relating to a Big Brother / Big Sister?
 Yes  No  (If yes, briefly explain.)

Do you receive any income assistance?  Yes  No

Living situation? 

 If other, please specify:

 
Family Annual Income Range:
 
Does your child have a parent or other significant family member who is incarcerated?   Yes  No
  If yes, who? 
 
Does you child have a parent or other significant family member who is on probation or parole?  Yes  No
  If yes, who? 
 
Is your family a victim of the hurricanes (Katrina or Rita)?   Yes  No
 

When and where would it be most convenient to talk with you and your child(ren) to begin the match process?
   

 

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