Mentee Application

Power Play is a free 8-week sport-mentoring program that aims to increase the availability of accessible and inclusive sport and recreation opportunities in Ajax, Pickering, Oshawa, and Whitby. Children and youth between the ages of 6 to 16 will engage in 1 of 4 unique sport programs that are led by certified coaches and Big Brothers Big Sisters mentors. Participants will develop fundamental movement and sport skills, learn about good decision making, and develop healthy relationships that will empower them to engage in sport and active living throughout their life.

To enroll your child in Power Play, please complete the form below. Completing this form does not guarantee entry into the program. Registration for Power Play is on a first-come, first-served basis. Upon registration you will receive an email to confirm enrollment. If the program is full you will have the option to place your child on the waitlist.

Please submit the completed form to Li-Ann at or drop the form off at the BBBS Ajax-Pickering office. The information provided in this package will be kept confidential and used to support program development so that we can provide participants with a best fit program.

Getting to know your child

Sex / M / F
Child’s Name / Date of Birth (mm/dd/yyyy)
School / Grade
Parent/Guardian Name / City/Town
Why does your child want to take part in Power Play?
Does your child currently participate in any organized sport programs? Have they participated in any organized sport programs in the past? If so, please list them.
How did you hear about Power Play?

Please identify the TWO (2) sports your child is most interested in participating in. Your child will be placed in ONE program. As stated above, the completion of this form does not guarantee entry into the program.

ü / Sport / Gender / Age / Capacity / Location / Day / Dates / Time
Volleyball / Co-ed / 10 to 12
13 to 16 / 30 / Sherwood PS / TU / Mar 3 – Apr 28
No programs Mar 17 / 6:15pm – 7:45pm
Soccer / Co-ed / 6 to 9
10 to 12 / 30 / Pickering Soccer Fields / TH / Mar 5 – April 30
No programs Mar 19 / 5:30pm – 7:00pm
Basketball / Female-only / 10 to 12
13 to 16 / 30 / Abilities Centre / WE / Mar 25 – May 13 / 4:30pm – 6:00pm
Floorball / Co-ed / 10 to 12
13 to 16 / 20 / TBC –
Cadarackque PS / SA / Apr 11 – Jun 6
No programs May 16 / 10:15am – 11:45am
Dress code: In order to safely participant in the program, all participants must wear gym attire. This includes running shoes, track pants/shorts, a t-shirt and/or sweatshirt. Does your child need support to obtain these items? / Y / N
Transportation: Does the participant have transportation to and from the program? / Y / N
If no, do you give permission for the participant (10+) to walk to/from Power Play on their own? I understand that Power Play mentors and coaches are not responsible for such participants upon dismissal. / Y / N
If yes, please list the name(s) and relationship(s) of the individual who will be providing the participant with transportation
Absences: If your child cannot attend a Power Play session, the Power Play Project Coordinator must be contacted at 905-831-3777 a minimum of 10 hours prior to the day of the program absence. Two (2) unreported absences may result in your child being removed from the program.
Parent/Guardian Signature / Date
Phone / Email

Release of Liability, Waiver of Claims, Assumption of Risks and Indemnity Agreement. Please Read Carefully!

I recognize that risk of injury or potential health risk may be involved in participation in the above-named program/activity. I hereby willingly assume such risk of injury or health risk for myself or for the above-named person(s) for whom I am in law responsible and assume full responsibility before, during and after my/their participation in the program/activity and any associated or related activities.

In consideration of the acceptance of my application and the permission to participate in the program/activity, I, for myself, my heirs, executors, administrators, successors and assigns HEREBY RELEASE, WAIVE, AND FOREVER DISCHARGE Big Brothers Big Sisters of Ajax-Pickering and Big Brothers Big Sisters of Oshawa-Whitby, all other organizations, associations and companies associated with any of the programs offered by Big Brothers Big Sisters of Ajax Pickering and Big Brothers Big Sisters of Oshawa-Whitby, and all their respective agents, employees, officials, servants, contractors, representatives, elected and appointed officials, successors and assigns OF AND FROM ALL claims, demands, damages costs and actions whatsoever and however caused, arising or to arise by reason of my participation in the program or any of its associated activities.

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