Big Brothers Big Sisters of Central Iowa - Child Inquiry Form
To learn more about enrolling your child, please either complete the form below, or call Grace Breiholz, Child Enrollment Coordinator, at 515-288-9025 x237. If you choose to complete this online form, we will be in contact to gather more information about your child and provide details about the enrollment process.
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Email *
Parent/Guardian First Name *
Parent/Guardian Last Name *
Child's First Name *
Child's Last Name *
Child's Gender
Child's Date of Birth *
We are only able to enroll children Kindergarten through 13 years old. When children on our waiting list reach 14 years old, they, unfortunately, are aged out of our waiting list. If your child is matched with a Big Brother or  Big Sister before they turn 14, they are eligible to stay matched within our program until they turn 18 years old or graduate from high school. If you have any questions regarding age and eligibility for our program, please contact BBBS (see top of form for contact information).
Parent/Guardian Phone *
Parent/Guardian Type of Phone *
Zip Code *
We are only able to enroll children and families who live in Polk, Warren, and/or Dallas county. If you do not reside in one of these counties, we encourage you to visit Iowa Mentoring Partnership for a list of mentoring agencies that serve your area. If you do not currently live in one of these counties, but will be moving to one soon, please indicate that below.
Child's current school *
If your child is eligible, would you also like information about our School-Based mentoring program? This program often has shorter waiting period than our community-based mentoring program. *
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