Game On Registration

I hereby give permission to BIG BROTHERS BIG SISTERS OF OXFORD COUNTY to make available their service to my child. It is my understanding that the intention of the Agency is to offer my child an opportunity to participate in a group program lead by a responsible adult, (minimum 18 years old, however, where appropriate supervision takes place, the volunteer may be younger), I understand that all efforts will be made to select a responsible Mentor who will facilitate the group program. In consideration for this service and other valuable consideration provided to my child by BIG BROTHERS BIG SISTERS OF OXFORD COUNTY, I release the agency of all responsibilities and liabilities in connection to their services provided in good faith, to myself or my child. I permit the agency to release any relevant information, including my personal information, to Big Brothers Big Sisters of Canada and their insurers, as may be appropriate in connection with any legal proceeding, inquiry or risk thereof. I understand that the collection of personal information about me or my child will be held in strict confidence and is to be used solely for the purposes of administering the program. I further agree that information about my child may be shared, at the discretion of BIG BROTHERS BIG SISTERS OF OXFORD COUNTY with the group facilitator so that my child’s needs may be best met. I understand that this application is the property of BIG BROTHERS BIG SISTERS OF OXFORD COUNTY. I also agree that my child will participate in the Pre- Match Training Program administered by BIG BROTHERS BIG SISTERS OF OXFORD COUNTY. I HAVE READ AND UNDERSTAND THIS AGREEMENT. BY CHECKING "YES" TO THIS AGREEMENT, I ACKNOWLEDGE THAT: I am the parent/guardian of the child mentioned above, and I hereby request Big Brothers Big Sisters service for my child. I give my child permission to participate in one or more group programs offered by BIG BROTHERS BIG SISTERS OF OXFORD COUNTY I am aware of and understand the risks, dangers and hazards associated with the above service and agree such service is suitable for my child.

I am aware that my child/youth will be asked to turn on their Zoom camera at the beginning of each session to confirm their identity to the Game On Program Coordinator and Game On Facilitators. This is one of the steps completed to help protect the participants of the group from unknown individuals joining the group. The child/youth is welcome to turn off their camera after the identity check/attendance is completed.

By checking 'Yes' below you are providing your consent for your child to engage in the Online Game On Program, and have virtual contact through Zoom with up to twelve other program participants and 3 volunteer mentors for the duration of the program. The group will be monitored by Big Brothers Big Sisters Staff member at all times. You can find Zoom's privacy policy here: https://zoom.us/privacy I understand that: · as the parent/guardian, the group will adhere to the following rules which will be reinforced in the first few minutes of the meeting: o No sharing of personal contact information will be a highlighted rule o No screen sharing between participants o No private chats between participants · Any communication between your child/youth and other program participants that takes place outside of the Game On online platform and/or service-delivery dates cannot be monitored by the Mentoring Coordinator and should be approved and monitored at your discretion. I agree to: · provide continued supervision and support, checking in with my child following each group meeting and throughout the ten weeks, to determine how my child is responding to the program. - Ensure group privacy by not reading the chat room conversations. · contact BBBS immediately should any concerns arise related to my child’s participation in this program. · contact the Mentoring Coordinator if I or my child needs support to access and/or adjust to the online Game On program. · do my best to support my child’s participation in the weekly group meetings.