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

VOLUNTEER ENROLLMENT

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).
Referral Source:    Referral Source (Other):
Program of interest: 
Community-based  School-based       Boys & Girls Club
Seton Home          St. PJ's Home      Transplants for Children
Name (First, Middle, Last):   SSN:
DOB:/ /   Gender:  
Ethnicity (select one):       Ethnicity (Other):  
Religious Affiliation:      Place of Worship:
Home Address: City:  State:     Zip:
E-mail Address: Home Number:  
Work number:    Cell phone number:     FAX number:  
 
Marital Status: 
Education: Are you currently attending school? Where?
Are you in the Military?      If "Yes",  Branch of Service:
    Duty Station:    Rank:
Employer:     Occupation:  
Employer Address, City, State, Zip:   
Can we contact you at work? Work hours:  How long employed:
 
Possession of a driver's license is required if you will be transporting a youth in any vehicle you are operating.

Do you have a driver's license?    
If yes, state of issue and number:    Expiration date:

 
Have you ever been arrested/convicted for a illegal offense?  
Status/Degree:
Are you currently charged with (indictment or official criminal complaints by county or district court) a felony or misdemeanor, including deferred adjudication? 
Have you ever been or are you currently being investigated for allegedly abusing, neglecting, or exploiting children, the elderly or the disabled?

If you answered "yes" to any of the last three questions, please list details, including the degree, city, state, and county of the event:  
Do you have any communicable diseases? 
     If yes, please describe:

REFERENCES

Please type or print information requested for four references:  1) your current or past employer who has known you for at least 1 year;  2) a co-worker or friend who has known you for at least 2 years;  3) a close family member (spouse/domestic partner) or a second friend who has known you for at least 3 years; and 4) someone who has known you for at least one year.

Our primary method of contact for these volunteers is by email. This is the fastest, most cost effective way of contacting a large number of people, and ensures privacy and security. Whenever possible, please list your references' email.

1. Employer's Name (or school if student):
    Supervisor's Name (or teacher if student):   
    Address 1:    
    City, State & Zip:
    Daytime Phone Number: 
    Email Address: 
2. Coworker or Friend:
    Address 1:    
    City, State & Zip:
    Daytime Phone Number: 
    Email Address: 
3. Spouse/Domestic Partner or close family member:
    Address 1:    
    City, State & Zip:
    Daytime Phone Number: 
    Email Address: 
4. Friend:
    Address 1:    
    City, State & Zip:
    Daytime Phone Number: 
    Email Address: 

WAIVER OF CONFIDENTIALITY

I, , am aware that Big Brothers Big Sisters of South Texas (the "Agency"), has an obligation to the Little Brothers and Sisters with whom applicants are matched, not to expose them to role models that may improperly influence them or adversely affect them in any way. In light of the responsibility of the Agency to such children and their parents, I do hereby knowingly and voluntarily consent to the disclosure to the Agency of any records or information pertaining to my application or which may be used by the organization to determine my suitability as a volunteer in the program. Such information may include, but shall not be limited to, employment records, records of any law enforcement Agency, references, psychological evaluations or testing results, medical records, and the records of any other agency or organization which utilizes volunteers.

I understand that all information provided to and obtained by the Agency will be held in the strictest of confidence. The Agency may, however, disclose to other agencies and organizations which utilize volunteers, the fact that I applied for and/or served with the Agency as a volunteer. Furthermore, all information obtained by the Agency shall be deemed to be the sole property of the Agency, and shall not be available to me or anyone outside the Agency, excepting parents of prospective Little Brothers or Little Sisters during the matching process, unless written authorization for the disclosure of information has been obtained from me. I understand and agree that I am not obligated if called upon, to perform services of a Big Brother or Big Sister and that the Big Brothers and Sisters Agency is not obligated to assign, or actively seek to assign, a child to me.

I agree to inform Big Brothers Big Sisters if I am named in complaints or indictments or convictions of a felony or a misdemeanor, including deferred adjudication. I also agree to inform Big Brothers Big Sisters if I am investigated for allegedly abusing, neglecting, or exploiting children, the elderly, or the disabled.

I agree to maintain my auto liability insurance and will notify BBBS of any changes made to that coverage throughout my participation in the Big Brothers Big Sisters Program.

I hereby release and discharge the Agency, as well as all organizations, agencies, corporations, partnerships, governmental entities, individuals, and any other person or persons from all actions, causes of action, claims, demands, and liabilities for or by reason of the disclosure or use of information provided to the Agency pursuant to this Waiver of Confidentiality.

Type  "I AGREE" in all caps in the box below:
  Date: