Little Moments. Big Magic.™
Sign Up To Be A Big Brother Or Sister

Name

Date of Birth (Must be at least 18)

Address

City

State

Zip

Phone

Cell Phone

Work Phone

Gender
Male   Female  
Do you have liability insurance on your vehicle?
Yes   No  
Do you have transportation?
Yes   No  
Can you give a one year, 12 hours/month committment?
Yes   No  
KSU students: Do you stay in Portage County during the summer?
Yes   No  
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