You Belong Youth Retreat Registration

You Belong - CSRC Youth Retreat Registration

Registration Deadline: Tuesday, September 13, 2022
Are you a participant or a leader?*
- I am a participant
- I am a leader
Name*
First Last
Address*
Street Address Address Line 2 City Province Postal Code
Phone*
Email*
Ontario Health Card Number
Date of Birth*
Doctor's Name
Dr's Phone
Parent/Guardian 1:
Name*
First Last
Home Phone*
Cell Phone
Parent/Guardian 2:
Name
First Last
Home Phone
Cell Phone
Work Phone
Emergency Contact 1:
Name*
First Last
Phone*
Relationship*
Emergency Contact 2:
Name*
First Last
Phone*
Relationship*
Custody Arrangement (if any):
Please list any allergies/susceptibilities to foods, fly bites drugs, or other:
Are there any medical conditions we should be aware of?
Please provide details of symptoms and appropriate course of action.
Is medication to be given?
- Yes
- No
Is there anything else we should know about you to ensure you have the best possible experience at this event?
Participant Code of Conduct Agreement
Youth participants will:
• Project an image of Christian consideration, sensitivity, and respect to everyone and to the property around them through language, dress, and behaviour
• Refrain from inappropriate touching, verbal harassment and profanity
• Respect other persons and/or property
• Refrain from actions that could result in injury and/or damage to property
• Adhere to stated curfew
• Attend all scheduled activities, arriving promptly, and staying for the entire event
• Be aware of noise levels in lobbies, hallways, and sleeping areas, especially later in the evenings
• Maintain the spirit of the event
• Follow the direction of adult leadership
• Remain in groups of at least three persons (including one adult leader) during off site time
• Report problems of any kind to a trusted adult
Youth participants will not:
• Possess weapons of any kind • Purchase, possess, consume, or distribute alcohol, tobacco or cannabis
• Purchase, possess, consume, or distribute illegal drugs
• Engage in any form of sexual activity or peer sexual harassment
• Visit or gather privately in sleeping quarters
Youth participants will be aware of what are and are not appropriate behaviours in terms of relationships between adults and youth, and with their peers:
The following behaviours are generally considered appropriate at a Canadian Shield Regional youth event:
• Side hugs
• Shoulder to shoulder hugs
• Handshakes
• “High-fives” and hand slapping
• Verbal praise for a job well-done (not regarding physical attributes)
• Touching hands, faces (usually in context of a blessing), shoulders, and arms of minors
• Arms around shoulders
• Holding hands while walking with younger minors
• Sitting beside younger minors
• Kneeling or bending down for hugs with younger minors
• Holding hands during prayer
• Pats on the head when culturally appropriate
The following behaviours are generally considered inappropriate at a Canadian Shield Regional youth event:
• Inappropriate or lengthy embraces
• Kisses on the mouth
• Holding children on the lap who are capable of sitting on their own
• Touching bottoms, chests, or genital areas
• Showing affection in isolated areas of a facility such as bedrooms, restrooms, bathrooms, closets, staff only areas, or other private rooms
• Being in or on a bed with an adult
• Touching knees or legs of minors
• Wrestling with minors
• Tickling minors
• Piggyback rides
• Any type of massage given by minor to adult or another minor
• Any type of massage given by adult to minor
• Any form of unwanted affection or peer sexual harassment
• Compliments or put downs that relate to physique or body development
• Going to an isolated area away from the group, or being taken to an isolated area by an adult or peer
If a problem of any kind occurs during a Canadian Shield Regional youth event, young people will immediately go to a trusted adult to discuss the matter. Youth and parents understand that failure to agree to and abide by the Youth Code of Conduct will bar youth from participation in any Canadian Shield Regional youth event.
Youth Participant Sanctions for Non-Compliance:
Canadian Shield Regional Youth never has direct responsibility for chaperoning the conduct of youth participants in its programming and events. Canadian Shield Regional Youth relies on group leaders from participants’ home congregations or other chaperones to ensure that every young person attending an event is aware of the Youth Code of Conduct and the sanctions for noncompliance. Group leaders, chaperones, and/or parents bear the responsibility for sharing this information with youth participants. Their failure to do so does not excuse any inappropriate behaviour on the part of youth participants nor does it affect Canadian Shield Region’s ability to levy sanctions. Youth participants are held to the Youth Code of Conduct regardless.
If a young person violates the Youth Code of Conduct, any or all of the following sanctions may be implemented:
• Reporting of misconduct to local authorities, if the violation in any way violates local ordinances or laws.
• The parents will be notified of the incident and the actions taken by the congregational group leader or chaperone in charge.
• Dismissal of the youth from the Canadian Shield Regional Youth event or program by requesting that the group leader remove the youth from the event (whereby it is the responsibility of the parent to ensure timely, accompanied, and safe transportation home).
I/we have read the Canadian Shield Region Youth Participant Code of Conduct and support my youth’s participation in the YOU BELONG CSRC Youth Retreat.
- I/we agree to the terms of this Youth Participant Code of Conduct Agreement
Signature of Parent/Guardian
Printed Name of Parent/Guardian
First Last
Date
MM slash DD slash YYYY
As a youth participant of YOU BELONG Youth Retreat, a Canadian Shield Region Youth Event, have read the Participant Code of Conduct and agree to abide by it. I also accept the consequences for my actions, if I choose not to follow the code.
- I agree to the terms of this Youth Participant Code of Conduct Agreement
Signature of Participant
Printed Name of Participant
First Last
Date
MM slash DD slash YYYY
Waivers (Health and Photography/Website)
HEALTH WAIVER: I understand that while every care and attention will be given to the health, safety and comfort of the participant, Canadian Shield Region of the United Church of Canada, and its affiliated organizations and individuals, cannot be held responsible for injuries sustained by my child as a result of his/her participation in this program. I(we) understand that, in the event medical treatment is required, every effort will be made to contact me. However, if I cannot be reached, I give permission for the staff or sponsor to secure the services of a licensed health professional to provide the care necessary, including anaesthesia, for my child’s well-being. I agree to accept financial responsibility for costs in excess of the benefits allowed under the Ontario Hospital Insurance Plan.
- I agree with waiver
- I do NOT agree with waiver
PHOTOGRAPHY/WEBSITE WAIVER: I give permission for the United Church of Canada to use my/my child’s photo from the Niagara Youth Festival in publicity and/or with articles about this event, as well as on websites and Facebook pages belonging to the United Church of Canada and/or its affiliates. I understand that names will not be used without express permission.
- I agree with waiver
- I do NOT agree with waiver
Signature of Parent or Guardian (if participant is under 18 years of age)
Printed Name of Parent or Guardian
First Last
Date
MM slash DD slash YYYY
Signature of Participant*
Printed Name of Participant*
First Last
Date*
MM slash DD slash YYYY
Payment
If you need to discuss payment options for this retreat, please contact Melody Duncanson Hales at mduncanson-hales@united-church.ca
Retreat Cost
Price:
Total
$ 0.00 CAD
Credit Card
Card Details
Cardholder Name

You Belong - CSRC Youth Retreat Registration

Registration Deadline: Tuesday, September 13, 2022

Parent/Guardian 1:

Parent/Guardian 2:

Emergency Contact 1:

Emergency Contact 2:

Participant Code of Conduct Agreement

Waivers (Health and Photography/Website)

Payment