North Bay: 1-833-236-0281 Ext. 1 | Thunder Bay: 1-833-236-0281 Ext. 7 info4RC06@united-church.ca

You Belong - CSRC Youth Retreat Leader Registration

  • Registration Deadline: Tuesday, September 13, 2022

  • Parent/Guardian 1:

  • Parent/Guardian 2:

  • Emergency Contact 1:

  • Emergency Contact 2:

  • Please provide details of symptoms and appropriate course of action.
  • Leader Code of Conduct Agreement

    If you are not a leader at this event, please skip down to the Participant Code of Conduct Agreement.
  • Young people are the most important gifts God entrusts to us. As an adult participant in the Canadian Shield Youth YOU BELONG Youth Retreat Event, I promise to strictly follow these policies and the following standards as a condition of my providing services to Canadian Shield Regional Youth.

    I will conduct myself in a manner that exhibits the highest Christian ethical standards and avoids even the appearance of impropriety, and therefore I will:

    1) Report suspected abuse of any minor to the appropriate authorities.

    2) Cooperate fully in any investigation of abuse of minors.

    3) Develop and maintain the level of skill required to be competent.

    4) Be knowledgeable of and adhere to all applicable aspects of the Code of Ethics for Youth Ministry in the United Church of Canada

    5) Be knowledgeable of and adhere to all aspects of the United Church of Canada’s Sexual Abuse Prevention and Response Policy

    6) Treat everyone with respect, loyalty, patience, integrity, courtesy, dignity, and consideration.

    7) Honour the equality of all people, avoiding all forms of discrimination and respecting the dignity of each person without regard to economic status, age, gender, race, ethnicity, religion, sexual orientation, or physical or mental abilities.

    8) Use positive reinforcement and communication rather than criticism, unhealthy competition, or comparison.

    9) Become thoroughly familiar with the objectives and guidelines of the program in which I am participating and strive to achieve these objectives and communicate them appropriately.

    10) Be aware of and adhere to emergency plans and evacuation routes appropriate to the program in which I am participating.

    11) Be responsible and/or accountable for stewardship of all resources entrusted to my care.

    12) Uphold the authority of those responsible for the program or activity in which I am participating and assist them in every way to encourage learning and to conduct fair and impartial events.

    13) Avoid situations where I am alone with minors, always following the two adult rule.

    14) Avoid any form of excessive familiarity, inappropriate language, or any situation and conduct that exploits or could give the appearance of exploiting another.

    15) Follow practices that consistently exhibit no tolerance for any form of abusive behaviour.

    16) Follow practices that demonstrate appropriate relationships between all Canadian Shield Regional adult participants and minors that are important for a child’s development and a positive part of ministry.

    I will not:

    1) Use physical affection to initiate inappropriate contact with minors.

    2) Touch a minor in a sexual or other inappropriate manner.

    3) Smoke or use tobacco or cannabis products in the presence of minors.

    4) Purchase tobacco or cannabis products for or distribute such products to minors.

    5) Use, possess, or be under the influence of alcohol or cannabis while supervising minors or while participating in a Canadian Shield Regional Youth event.

    6) Purchase alcohol or cannabis for or distribute alcohol/cannabis to anyone under the age of 19 years.

    7) Use, purchase, possess, distribute, or be under the influence of illegal drugs at any time.

    8) Purchase, download, possess, or distribute pornography.

    9) Pose any known health risk to minors (i.e., no fevers or other contagious situations).

    10) Humiliate, ridicule, threaten, demean, nor degrade minors or others nor tolerate such behaviour in the environment for which I am responsible.

    11) Use physical discipline in any way for behaviour management of minors. No form of physical discipline is acceptable. This includes but is not limited to spanking, slapping, pinching, shaking, hitting or any other physical force as retaliation or correction for inappropriate behaviour of a minor.

    12) Use profanity in any form in the presence of minors.

  • The Code of Ethics for Youth Ministry in the United Church of Canada can be found here: https://united-church.ca/sites/default/files/handbook_code-ethics-youth.pdf
  • The Sexual Misconduct Prevention and Response Policy and Procedures can be found here: https://united-church.ca/sites/default/files/2021-01/sexual-misconduct-prevention-response-2020.pdf
  • I hereby represent that I am not currently being investigated for, nor have I ever been convicted of an offense that would preclude working or contact with minors; I have never been terminated from employment or a volunteer position for reasons related to allegations of physical or sexual abuse by me; nor have I sought or received any medical, physical, or psychological treatment for reasons involving physical or sexual abuse by me; I have submitted to a process of volunteer screening and police records check within the duty of care policies of my congregation, pastoral charge or community of faith.

    I understand that should my response to any of the statements above change, I am obligated to inform my congregation and Canadian Shield Regional Council immediately. Moreover, I understand that should I admit to, plead no contest to, or be found guilty of an incident of sexual misconduct or other disqualifying offense, or if it appears that an alleged claim is substantiated; my services with Canadian Shield Regional Youth events shall be immediately terminated. Further, I understand that my failure to agree to and abide by the Adult Code of Conduct will bar me from participation in any Canadian Shield Regional Youth event.

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  • Waivers (Health and Photography/Website)

  • 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 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.
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