Contact: 781-516-2090

Enroll a Child

Child Enrollment Form

Child’s full name:*
First Last
Child’s address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Does child reside full-time at this address?*
- Yes
- No (If “no,” provide secondary address)
Secondary address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Child’s date of birth (if known):
Child's gender description:
Child's pronouns (if known)
- He, him
- She, her
- They, them
- Other (describe below)
Describe:
I am referring this child for consideration in (check all that apply):
- Community Program
- School Program (participating Newton and Needham schools only)
- LGBTQ+ Program
- College Mentoring Program (High School Juniors/Seniors)
- Type 1 Diabetes Program
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'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's parent/guardian (if known):
In a sentence or two, please indicate why you think the child could benefit from a relationship with a Big Brother/Sister.*
How did you hear about us - and if a referral from someone currently involved with JBBBS, please share their name?*
- A Friend or Family Member (indicate name below)
- Another Big Brother/Sister Affiliate
- My child’s sibling is/was enrolled (indicate name)
- My child’s school (indicate name below)
- My child’s therapist or guidance counselor (indicate name below)
- I was a Little in the Big Brothers Big Sisters Program
- Big Brothers Big Sisters of America Website
- Another service organization (indicate which organization)
- My place of worship (indicate which)
- Company, Business or Employer (indicate which below)
- Other (describe)
Please indicate referrals below.