BBBS of the Lowcountry Little Enrollment Interest Follow Up
As Big Brothers Big Sisters of the Lowcountry begins to take steps to reopen following COVID-19, we are updating all our files and would like to ensure the information we have on YOUR family and child is up to date! Should you have continued interest in having your son/daughter participate in our program and want to keep them on our waiting list, we ask that you complete this questionnaire as soon as possible. Please note that we take great care in learning about children and families because we work to find select the BEST, most compatible Big Brothers and Big Sisters. The specific questions below are all critical and help ensure we succeed in that quest. Also, you can rest assured that our official policies require that we keep ALL the information you share STRICTLY CONFIDENTIAL. We promise we will only use it to process your application and to assist in the match-making process.
Personal Information:
Parent/Guardian Full Name
*
First Name
Last Name
Personal E-mail (please no work emails)
*
Phone Number
*
-
Area Code
Phone Number
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Relationship to Child
*
Mother
Father
Grandmother
Grandfather
Foster Parent
Social Worker/Caseworker
Guidance Counselor
Other Family
Child's Full Name
*
First Name
Last Name
Child's Birthday
*
-
Month
-
Day
Year
Date
Child's Gender
*
Male
Female
Trans Female
Trans Male
Non-binary
Child's Race/Ethnicity
*
Asian American
Black or African American
Chinese
Filipino
Hispanic-Cuban
Hispanic-Mexican
Hispanic-Other Latinx or Hispanic Origin
Hispanic-Puerto Rican
Japanese
Korean
Middle Eastern or North African
Native Hawaiian
Other Asian
Other Pacific Islander
Samoan
South Asian
Some other race
Vietnamese
White or Caucasian
Child's Religious Affiliation
*
None
Agnostic
Buddhist
Catholic
Hindu
Islamic
Jewish
Mormon/LDS
Protestant
Quaker/Mennonite
Other/Unknown
Baptist
Methodist
Nondenominational
Christian: Other
Presbyterian
Lutheran
Episcopalian
Seventh Day Adventist
Evangelical
Eastern Orthodox
Scientology
African Methodist Episcopal
Amish
Greek Orthodox
Jehovah's Witnesses
Pentecostal
Salvation Army
Unitarian
United Church of Christ
Shamanism
Wicca
Traditional Native American
Do you know if your child has a sexual orientation yet?
*
No
If yes, please explain
If yes, please describe:
Child's rising grade
*
Child's school
*
Does your family receive income assistance?
*
yes
no
Does your child receive free/reduced lunch?
*
yes
no
Does your child have an incarcerated parent?
*
yes
no
Does your child have a military parent?
*
yes
no
Does your child have a deployed parent?
*
yes
no
What is your child's current family living situation?
*
One Parent: Female
One Parent: Male
Two Parents: Not Married
Two Parents: Married
Grandparents
Foster Home
Group Home
Other Family
Does your child have any mental health/developmental diagnoses?
*
If yes, please explain below
yes
no
Mental health/developmental diagnosis
Do you own/have access to a tablet/laptop for your child to communicate with their Big?
*
Yes
No
Beyond your phone/hotspot, do you have reliable WiFI/Internet for your child to communicate with their Big?
*
Yes
No
Why would you like to enroll your child into the BBBSL program?
*
Emergency/Alternative Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
-
Area Code
Phone Number
Submit
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