Wampum: Aboriginal & Non-Aboriginal Youth Experience Junior Leaders Five Oaks Centre, 1 Bethel Rd. Paris, ON

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Jayson Jacobs
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1 Wampum: Aboriginal & Non-Aboriginal Youth Experience Junior Leaders Five Oaks Centre, 1 Bethel Rd. Paris, ON Wampum Junior Leaders is an opportunity for Aboriginal and non-aboriginal youth (ages 15-16) to develop leadership skills as they help lead activities during Wampum and learn about how we build friendships between cultures. The adventure will include: 1. A trip to the Mohawk Institute (former residential school), 2. Learning about the Church s role in the schools and ongoing work towards reparations, healing and reconciliation, 3. Teachings about the natural and cultural history of the Grand River, 4. Rafting on the Grand River and swimming in the pool at Five Oaks Dates: July 20-24, 2016 Cost: Pay What You Can. The true cost of this camp is $ per camper. We ask you to consider your own resources and Pay What You Can, with a suggested minimum of $100. (Financial help may be available from a local church, Band Council, Service Club, etc ) Your ability to pay will not impact our decision on your child s application! Application Deadline: June 1, 2016 We will notify applicants by June 15th of approval of application. Please send the application to: Five Oaks Centre Rivkah Unland R.R. #3, 1 Bethel Rd. Paris, ON N3L 3E3 Or to registrar@fiveoaks.on.ca

2 Wampum Junior Leader Application Form Applicant s Name: Gender Identity: Date of Birth: Age on July 1, 2016 Entering Grade: Address: Street / City / Province / Postal Code Address (confirmation of acceptance into the program will be sent to this address): Phone Number: Roommate request: Have you attended Wampum as a participant in the past? Please tell us the ethnic group that you identify with: If you are Aboriginal please tell us your nation/community: If you are Aboriginal please tell us if you live on reserve or off reserve: List any dietary needs, allergies (food or otherwise), physical needs or health concerns that we need to know about: Bring any medication in original bottles and label with your name. List medication that you will be bringing to Five Oaks: Health Card Number: Doctor s Name: Doctor s Phone:

3 Name(s) of Parent(s)/Guardians(s): Cell Phone: Home Phone: Work Phone: Address: Additional Contact information in case of emergency who should we contact if you can t be reached? My child may be picked up by: My child may not be picked up by: The minimum registration cost of $100 is due once the application has been approved. If you are unable to pay the full amount please indicate how much you are able to pay:. (We are grateful for the many grants and donations that support this program. Each participant is subsidized by roughly $600. If you are able to pay more than $100 for your child to attend the program this would be greatly appreciated. Every little bit helps!) Signing below indicates you are consenting to the following: I give permission for the above named participant to attend Wampum and participate in all the activities in the program. I have disclosed all pertinent medical information including medications. I give permission to allow the named Family Doctor to give medical information should it be required. I permit the leaders of the program to use their judgment in determining the extent of immediate medical care as required and the possibility of using the emergency services of a hospital or clinic. I understand that Five Oaks has the right to dismiss a participant, who, in their opinion, has displayed unacceptable behaviour. I give permission for the participant named above to have their picture taken during the program and give Five Oaks permission to use the picture in promotional material including the Five Oaks Facebook page. (If pictures of your child cannot be shared please indicate this with a note here.) Parent/Guardian Signature: Date:

4 Please tell us why you would like to be a Junior Leader at Wampum. WAMPUM COVENANT Where we gather, we have responsibilities: responsibilities toward ourselves, responsibilities toward the others with whom we gather, responsibilities toward all the myriad forms of Creation. At Wampum, there is room for everyone to be themselves, to be free to explore, to discover, to create who they are, and who they want to be! We are sharing this sacred space at Five Oaks Centre. Five Oaks has trusted us all to take care of it, of our rooms, the shared space, the outdoor environment, and all around. Please respect all the boundaries set out by Five Oaks. Wampum is a unique experience and it is a privilege for you to be chosen to attend. You are choosing to come and participate in this special Wampum program. The success of our time together is up to you! Participate fully and to the best of your abilities in all the activities! There are new friends here! Be open to meeting them and treat everyone the way you would like to be treated, including their stuff and their need to sleep! We ask you to respect one another and refrain from sexual relationships, alcohol, drugs, smoking and breaking curfew. The leadership team has worked very hard to bring you this program and we too deserve your respect. To disrespect our standards is to disrespect us. If you think something should be different come and talk to us and we will be happy to work together. Come, enjoy and be present with the community that has gathered for Wampum. I have read and understand the Wampum Covenant. I promise to honour the Covenant while at Five Oaks. I understand that if I break this covenant I can be sent home from Wampum at my own expense. Signature of Junior Leader Applicant: Date:

5 GRAND RIVER RAFTING COMPANY WAIVER RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISK AND IDEMNITY AGREEMENT. Please note that by signing this agreement, you give up the right to sue for any injury or damages howsoever caused. TO: Grand River Rafting Company ( the Company ) and its directors, officers, employees, representatives and agents (collectively called the Agents ). I, hereby sign this agreement on behalf of myself, my personal representatives, heirs and assigns. 1. I agree as a precondition to my participation in all events organized by the Company and/or the Agents including but not limited to paddling, hiking, cycling, fishing, camping with other outdoor activities (collectively referred to as the Activities ) and in further consideration of the Company allowing me to do so, that I will be strictly bound by the terms of this Release of Liability, Waiver of Claims, Assumption of Risks and Indemnity Agreement ( the Agreement ). I acknowledge that the Activities involve inherent risks and dangers that may cause serious injury and possible death to participants. I fully understand the risks and dangers associated with my participation in the Activities and accept the same entirely at my own risk. I hereby waive any and all claims which I may have against the Company and the Agents and release the Company and the Agents from all liability for injury, death, property damage or any other loss sustained by me as a result of my participation in the Activities, due to any cause what so ever, including negligence, breach of contract, or breach of any statutory or other duty of care by the Company and/or the Agents. I appreciate that the Agreement limits the liability of the Agents to the same extent as it limits the liability of the Company, even though the Agents are not formal parties to the Agreement. I AM EIGHTEEN YEARS OF AGE OR OLDER, AND I HAVE READ AND UNDERSTAND THE AGREEMENT. I UNDERSTAND THAT THIS DOCUMENT CONTAINS A PROMISE NOT TO SUE THE COMPANY AND/OR AGENTS AND THAT IT CONSTITUTES A RELEASE OF LIABILITY AND AN INDEMNITY FOR ALL CLAIMS. IF I AM THE PARENT AND /OR GUARDIAN OF THE PARTICIPANT,I HAVE READ AND UNDERSTAND AND EXECUTE THE AGREEMENT ON BEHALF OF THE CHILD/ WARD WITNESS DATE SIGNATURE OF PARTICIPANT OR PARENT/GUARDIAN PRINT NAME PRINT NAME OF CHILD OR WARD

2017 Camper Application

Centennial Forest Environmental Education Programs 2017 Camper Application NAU Centennial Forest P.O. Box 15018 Flagstaff, AZ 86011 (928) 523-6727 Phone (928) 523-1080 Fax www.nau.edu/cfcamps Thank you