Enroll A Child

Through experiences with an adult friend, children gain self-confidence, exposure to different opportunities and the knowledge that another person cares.

1. Complete "Little Brother/Little Sister Registration" and submit online.
2. Complete "Consent for Release of Confidential Information" (pdf).
3. Mail the consent form to: BBBS, 801 N. Lincoln Drive, Hancock, MI 49930.
   

Little Brother/Little Sister Registration

Child's Information

Today's date	mm/dd/yyyy
Child's name	First Last
Date of birth	mm/dd/yyyy
Sex	male female
Grade	PreK K 1 2 3 4 5 6 7 8 9 10 11 12
Name of school
Teacher's name	First Last

Parental Information

Mother's name	First Last
Place of employment
Mailing address	Street/P.O. Box, Town, State, Zipcode
Street address	(if different from above)
Home phone	(xxx) xxx-xxxx
Best time to call:
Work phone	(xxx) xxx-xxxx
Best time to call:
Email address
Father's name	First Last
Place of employment
Home phone	(xxx) xxx-xxxx
Best time to call:
Work phone	(xxx) xxx-xxxx
Best time to call:
Complete mailing address	Street/P.O. Box, Town, State, Zipcode
Marital status of parents
Absent parent last in home	First Last
Child living with	mother father guardian other
Child referred to agency by	First Last
Referrer's email address

Siblings/Others in Home

Name	Sex	Birthdate	Relationship
First Last		mm/dd/yyyy
	male female
	male female
	male female
	male female

Referral Reasons

General Behavior		Specific Problem Areas
Deliquent, anti-social behavior		Parent/child relationship
Resentful of controls/authority		Sibling relationships
Relatively normal/conforming		School adjustment
Tends to have few friends		Physical symptoms: bedwetting, asthma, allergies, nervous tic, etc.
Daydreams		Physical disability: vision, hearing, heart trouble,etc.
Withdraws from social relationships		Other
Depressed

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