Find a Buddy
*This form is to be filled out by the adult parents/guardians of the child. We are an organization that is led by high schoolers with high school volunteers from all over California. Our volunteers are not approved by any hospital or healthcare professional, but the Blue Bloom team makes sure to conduct a thorough orientation before they work with your kids.
Create a special bond with kids with special needs and high school students and above. We will have two options either group, individual, or both depends on your child. The buddies can talk online, and this will give them some social interaction, especially during a lockdown.
* Required
Kid's name (First, Last)
*
Your answer
Age
*
Your answer
Gender
*
Female
Male
Other:
Parent's Name (First, Last)
*
Your answer
Parent's Email
*
Your answer
Parent's Phone Number
*
Your answer
Time Zone
*
Pacific Time Zone
Mountain Time Zone
Central Time Zone
Eastern Time Zone
Hawain Time Zone
Alaskan Time Zone
Other:
Availability (mark all the times your child is available)
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
8AM - 9AM
9AM - 10AM
10AM - 11AM
11AM - 12PM
12PM - 1PM
1PM - 2PM
2PM - 3PM
3PM - 4PM
4PM - 5PM
5PM - 6PM
6PM - 7PM
7PM - 8PM
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
8AM - 9AM
9AM - 10AM
10AM - 11AM
11AM - 12PM
12PM - 1PM
1PM - 2PM
2PM - 3PM
3PM - 4PM
4PM - 5PM
5PM - 6PM
6PM - 7PM
7PM - 8PM
What are your child's disabilities? (This is purely to help prepare the buddy.)
*
Your answer
Which programs is your child interested in?
*
One-on-one
Group Sessions
Required
Do you agree with the privacy policy? (Privacy Policy:
https://tinyurl.com/y8an23vj
)
*
Yes
No
Photo Release Form (
https://tinyurl.com/bluebloomphotorelease
)
*
Yes, I agree
No, I don't agree
Child's Interests
*
Academics
Video Games
Sports
Arts
Singing/Dancing
Outdoors/Traveling
Movies
Making/Building/Creating things
STEM
Talking about future/Tips
Cooking/Baking
Music
Other:
Required
Would you like your kid to try new hobbies, and what would those be?
*
Academics
Video Games
Sports
Art
Singing/dancing
Outdoors/traveling
Movies
Making/building/creating things
STEM
Talking about the future/tips
Cooking/Baking
Music
Other:
Required
What are your goals for your child? (ex: develop a hobby, get more social interaction, etc.)
*
Your answer
Anything we should know or be aware of.
Your answer
How did you hear about us?
*
Flyers
Social Media
Support Groups
Other:
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