Enrollment Form

To be completed by parent or guardian

Date of Inquiry:
(MM/DD/YYYY)		  
Parent's Name:  
Son's/Daughter's Name: Age:
Address:  
City:
 
State:
 
Zip:
 
Home Phone:
Cell Phone:
Email:  
Name of Employer:  
Work Phone:
 
Can we call you at work? Yes No  

Son's/Daughter's School:
Grade:
What is the primary reason for you wanting your son/daughter to have a Big Brother/Big Sister?
How did you hear about us?
Does your child have other siblings who could benefit from having a Big Brother/Sister?
When and where would it be most convenient to talk with you and your son or daughter so that we can start the process of getting them matched?
   
 

main logo Big Brothers Big Sisters of Fond du Lac
448 South Military Road
Fond du Lac, WI 54935