Consent Form (Page 2): Virtual Group

The Virtual group programming will support Children in a social emotional capacity, providing distance-based, virtual programming, through which our agency staff will facilitate program activities through online platforms.

Virtual Programming will be scheduled in advance and displayed on BGCBigs.ca website. Leadership, health, science, technology, engineering, math, arts, drivers’ education courses are just some of the categories of online learning your children/youth will be able to take part in.

You have referred your child to participate in the BGCBigs Virtual Group Program. It is a community service program designed to assist your son/daughter to reach his/her fullest potential and to assist in the enhancement of their Social, emotional learning skills.

Boys & Girls Clubs Big Brothers Big Sisters of Edmonton and Area will use software, tools and applications provided by third parties that members, parents/guardians and/or staff will access via the Internet and use for purposes of communication and programming. This platform is G Suite, using the Google Meets, Google Classroom, Google Sites and Google Docs applications.

This letter seeks consent for your child to utilize G Suite for distance-based, virtual program purposes. Google provides the opportunity to deliver video and chat-based educational experiences to members via any device. Please be aware that each application collects different information about its users and has its own privacy terms and conditions to which members must adhere. Please review these carefully before registering your member.

CONFIDENTIALITY and INFORMED CONSENT – FOR SERVICE

INFORMED CONSENT: I hereby give permission to Edmonton BGCBigs to make available their service to my child. It is my understanding that the intention of the Agency is to allow my child to participate in a virtual group program, with staff and potential volunteers, (minimum 18 years old, however, where appropriate supervision takes place, the volunteer may be younger), with my child for the purposes of shared activities, friendship, and support. I understand that all efforts will be made to provide a virtual program that is compatible with my child.

In consideration for this service and other valuable consideration provided to my child by BGCBIGS, 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 Edmonton BGCBigs, with volunteers or program partners that may interact with the virtual group program.

I understand that I am under no obligation to accept a Virtual group program for my child, that the Agency is under no obligation to provide my child admittance to a virtual group program and that this application is the property of Edmonton BGCBigs.

I waive my legal right against Boys & Girls Clubs Big Brothers Big Sisters of Edmonton & Area, employees and/or volunteers of Boys & Girls Clubs Big Brothers Big Sisters of Edmonton & Area, for any loss, injury or damage suffered during or by reason of medical attention and undertake to be responsible for any hospitalization, medical and ambulance expense.

As the Parent/Legal Guardian, or the Referring Individual I authorize Boys and Girls Club Big Brothers Big Sisters of Edmonton and Area to use the information provided within their agency. I am consenting to receiving programs and services for my family, or contact to be made with this family.  I agree that the information I have provided is true to the best of my knowledge. I acknowledge that some information will need to be shared with funding bodies as part of our agreement with municipal, provincial, and federal funding sources.

I agree to work in partnership with the staff and volunteers of Boys & Girls Clubs Big Brothers Big Sisters of Edmonton & Area to deal with any behavioural issues concerning my child. I understand that all data collected will adhere to Freedom of Information and Protection of Privacy Act and Personal Information Protection Act.

  • You grant permission for your son/daughter to participate in the BGCBigs Virtual Group Program.
  • This consent form is effective for the duration your child’s involvement of the BGCBigs Virtual Group program.
  • Your child will not have contact with any volunteers or program partners outside of program hours. If such contact is initiated, the program registration may be ended by the agency.
  • You and your child will be asked to complete program surveys and evaluations as part of regular follow-up and match monitoring of the program.
  • Your child’s teacher may be asked to also participate in the completion of surveys for evaluation information as requested by the BGCBigs
  • You understand that you have the right to examine your child’s file, and any child at 12 years of age has this same right. Such an examination may be requested through the principal of your child’s school (if applicable) or your program facilitator.
  • You release BGCBigs ­­­­­­­­­­­­­­­­­­­­­­­of all responsibilities and liabilities in connection to the services provided in good faith to your child.
  • Virtual Program Consent We will prohibit 1:1 contact between club staff and members. This means 2 staff will be present for every online session. One staff will be the moderator of the chat and one will facilitate the session.
  • Staff will only respond to families via email, text or phone between the hours 12:00 pm – 8:00 pm.
  • A new link for each program will be sent out weekly to families for each program.
  • Staff will review online safety guidelines including prohibiting exchanging personal information during programs (ie email addresses, social media address(s) or locations of personal profiles, mobile numbers or any other personally identifiable information. Chat logs are saved and stored internally.
  • Any online bullying will not be tolerated. Staff will respond quickly to any inappropriate behavior online and follow up with parents/caregivers to ensure they are informed of the incident. Please complete the form below to record your consent for your child’s use of G Suite.
  • You agree to your child participating in a Pre-Screen/Pre-match training call offered by the school and/or BGCBigs before your child is matched in a group. The Pre-match training program is designed to cover the following areas:

*understanding of what mentoring is, boundaries and stages of the mentoring relationship, including endings; safe and healthy relationships

*Communication enhancement – including keep and speak secrets

*role of your program facilitator.

INFORMED CONSENT FOR PROVISION OF SERVICE:

I, , parent/guardian of , hereby request Big Brothers Big Sisters service for my child.  I give the agency my consent to assign a Mentor to my child. 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.

CONFIDENTIALITY: The Agency believes in maintaining high standards of ethical conduct in the operation of the agency’s programs and the representation of them to the community, including a commitment to privacy and confidentiality within the limitations defined by law. The Agency adheres to all applicable Federal and Provincial Privacy legislation and is committed to protecting the professional and personal privacy and confidentiality of its volunteers, youth, and their families.

All individuals in a position of trust within the agency are required to sign a privacy/confidentiality agreement.   This includes staff, family and volunteers.   It is important to understand that information will be shared with other staff only as needed for service to your child or family.    Care will be taken that information to any involved professional outside of the agency is only released with the signed consent of the family except in the case of concern of child abuse or neglect, where staff are required by law to inform the proper authorities, which could result in the disclosure of confidential  information.

CONFIDENTIALITY AGREEMENT

I, , parent/guardian of , have read the BGCBigs statement on confidentiality and do understand and agree.

CONSENT FOR AUDIO / VISUAL RECORDING

On occasion, your child’s photo may be taken in relation to their participation with BGCBigs.  These photos may be used in promotional materials and advertisement including brochures, posters, newsletters, media information, advertisements, audio-visual productions and web pages, such as the Agency website and social media.  Photographs or video productions may also be shared with community and school partners for program promotion.

I, , parent/guardian of provide consent that my child can be photographed, videotaped or recorded in conjunction with programs of BGCBigs and further agree that materials produced as a result are the property of BGCBigs (indicate yes or no below).