Enroll a Child or Teen

Child Enrollment Form

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Child or Teen's full name: *

Field label

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Child or Teen’s address: *

New Field:

Country

Does child or teen reside full-time at this address?

Yes

No (If “no,” provide secondary address)

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Secondary address:

Field label

New Field

Country

Child or Teen’s date of birth (if known):

Child or Teen's gender description:

Child or Teen's pronouns (if known)

He, him

She, her

They, them

Other (describe below)

Describe:

I am referring this child or teen for consideration in (check all that apply):

Community Program

LGBTQ+ Program

College Mentoring Program (High School Juniors/Seniors)

Type 1 Diabetes Program

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Referring adult’s name: *

First

Last

Referring adult’s preferred telephone number(s):

Referring adult’s e-mail:

Referring adult’s relationship to the child:

Parent/Legal guardian

Other relative (describe)

Teacher/Counselor

Clergy

Other (describe)

Describe:

If person completing form is other than parent/guardian, please provide the name of child or teen's parent/guardian:

If person completing form is other than parent/guardian, please provide parent/guardian's phone number (if known):

If person completing form is other than parent/guardian, please provide the e-mail address of child or teen's parent/guardian (if known):

In a sentence or two, please indicate why you think the child or teen could benefit from a relationship with a Big Brother/Sister.

Please indicate referrals below.

Thank you for applying to join the Friend 2 Friend program with Jewish Big Brothers Big Sisters of Greater Boston. A Friend 2 Friend Clinical Match Specialist will be in touch with you soon to discuss the next steps.

Child Enrollment Form

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