Enroll a Child

Enroll a Little

West Central Enroll A Child
* required information
Child Enrollment 
Please fill out your information followed by your child's:
Big Brothers Big Sisters has several program options, including some that we receive special funding for. In order to provide these additional support services, we need to ask you some questions pertaining to these special programs. Your answers will not influence your child's eligibility for the programs.
Parent/Guardian First Name:*
Last Name:*
Your relationship to the child you are enrolling:*
Address Line 1:*
Address Line 2:
City:*
State (Texas Residents Only):*
Zip Code (5-digit):*
County:*
Email:
Home Phone (ex. 555-555-5555):*
Business Phone:
Cell Phone:
Child's First Name:*
Child's Last Name:*
Child's Gender:* Male
Female
Child's Race:*
Child's Date of Birth:*(mm/dd/yyyy)
Child's Social Security Number:
How did you hear about us?:*
Alternate Contact Person Name:
Alternate Contact Person Phone Number:
Child's Living Situation:
If Other Living Situation, please specify:
Household Income Per Year:
How many people live in your home?:
Does your child receive Free/Reduced School Lunch?:* Yes
No
Do you or your children receive Family Assistance?: Yes
No
What is the primary reason for you wanting your child to have a Big Brother/Big Sister?:*
Do you have a close family member who is currently incarcerated, on probation or parole?:* Yes
No
Do you have a family member who previously was incarcerated, on probation or parole?:* Yes
No
If yes, what relation is the family member to the child?:
Does the child have a Parent/Guardian in the military? (LOD = Line of Duty):*
If yes, what relation are they to the child?:
Is that person currently deployed?: Yes
No
What is the status of the military member?:
Is your family a "Gold Star" military family?: Yes
No
Are you open to a volunteer who is older than 40?:* Yes
No
If you are enrolling a son, check the volunteer options you are open to matching with:* Big Brother
Big Sister (child must be 11 or younger)
Big Family
Big Couple
NA, Enrolling Daughter
Child's ISD:*
Child's School Name:*
Child's Grade:*
Child's Teacher:
Child's School ID #:
Has your child ever been held back a grade due to failure?:* Yes
No
If yes, what grade were they held back in?:
Did your child pass the Math portion of the TAKS/STAAR test in the 3rd grade?:* Yes
No
Did your child pass the Reading portion of the TAKS/STAAR test in the 3rd grade?:* Yes
No
Is your child expected to pass all of their classes this semester/year?:* Yes
No
Has your child had problems with truancy in the past?:* Yes
No
If your child has had problems with truancy in the past, please explain when:
Has your child been adjudicated in the past?:* Yes
No
Who is answering this question?:
If your child has been adjudicated in the past, please explain when:
What days/times of the week are you and your child available for an interview?:
During the summer, are you open for a weekday daytime interview?: Yes
No
        
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Serving: Abilene, Arlington, Brownwood, Collin CountyDallas, Denton County, Ellis County, Erath County,
Fort Worth, Grayson CountyHouston, Jack CountyParis, San Angelo, Stephenville, Waco, Wichita Falls

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