Okanagan Environmental Leadership Camp Registration Form

Dates: 10 to 17 June 2017

Location: Glimpse Lake, BC (Syilx territory, Upper Nicola Band)

Eligibility: Indigenous young adults ages 18-30.

VISIT THE OKANAGAN ENVIRONMENTAL LEADERSHIP CAMP 2017 EVENTS PAGE

 

Seats are limited! 

Register ASAP to avoid missing out on this life-changing experience! To apply for registration for this camp, please complete this form and click on the submit button at the end of the form. Required fields are marked with an asterisk (*).

This amazing opportunity is being offered to all Indigenous young adults in BC!

 

Are you a current Bridges program participant?* If yes, skip to the application questions, below.
YesNo

APPLICATION QUESTIONS

Personal Information

Gender*
FemaleMale

Birthdate*
/ /

Have you already been in contact with an organizer about applying? If so, whom?

Participant’s Consent to Basic Guidelines

We expect participants to attend the full camp- this will create a stronger sense of community and allow you to experience all the programming we have planned. In addition, we will be facilitating transportation to and from this remote location from one or more regional meeting points at the beginning and end of camp.

Will you be able to stay for the entire duration of the camp?* If not, please explain.
YesNo

The following non-negotiable guidelines have been established for participants of IndigenEYEZ gatherings to create a safe and respectful environment for everyone.

• No leaving the program grounds without authorization • No coupling/no sex • Check-in all valuables including money, electronic equipment, passports, etc. with the camp manager for safe keeping at registration? • No drugs, tobacco or alcohol

*PLEASE NOTE* DO NOT BRING: I-Pods, CD players, headsets or other electronics. If you forget and bring them, or need them for your travel to and from camp, we will ask you to check them in with the camp manager at registration (along with any other valuables). We will put them in a locked area for safe-keeping during camp. If you do not check in your valuables, and something goes missing at camp, we will assume you have misplaced, not that it was taken by anyone else. Please help us keep the positive energy going at the camp by checking in your valuables.

INDIGENEYEZ/GDF WILL NOT BE RESPONSIBLE FOR MISPLACED ITEMS.

Accommodation

Participants will be expected to bring their own tent and sleeping gear. After registration we will send out a detailed list of what to bring.

Please tick the items you do not have access - we may have spare items.

I understand that by signing this Form, by typing my name in the field below, I am agreeing to follow these guidelines, and that not following them could result in the loss of my ability to participate in the program.

Participant’s signature*

Date*

Emergency Contact Information (please note primary contact)

To plan and prepare more effectively, we have a few health and safety questions. Please note that this is merely to help us plan better, and these questions will not be used to select participants.

This is a land-based camp, and the majority of each day will be spent doing activities out on the land. Do you have any physical conditions that might limit your participation in these activities? If so, please list.

Dietary Needs

We are able to provide a vegetarian option for meals. Do you require the vegetarian option?*
YesNo

Are you a vegetarian?*
YesNo

Please note we will make an effort to accommodate dietary restrictions, but in a camp setting this may not be possible. We will contact you if we are unable to accommodate your restrictions.

Medical History

Do you have any recent hospitalizations, injuries, physical or emotional complaints, or chronic illness that affect you at this time?*
YesNo

Do you have or have you ever had any of the following:*
Heart conditionDiabetesSeizuresAsthmaNon-food related allergies

Is there any other medical information of which we should be aware?*
YesNo

Is the participant currently under the care of a physician or practitioner of any kind?*
YesNo

Are you currently taking medications of any kind?*
YesNo

Medical Release

I hereby give permission that I may be given emergency treatment by qualified personnel. I also give permission for myself to be transported by ambulance or aid car to an emergency center for treatment. In the event that I am unable to give consent and my emergency contact cannot be reached, I further consent to the medical, surgical, and hospital care, treatment, and procedures to be performed for me/ by a licensed physician or hospital when deemed immediately necessary or advisable by the physician to safeguard my health. I have read, understand and agree to the above listed statement and do sign this agreement of my own free will.

Hold Harmless Release Form

This information is necessary for your participation in the IndigenEYEZ Summer Camp. Each line must be selected by the participant as a sign of acknowledgement and understanding. Then type your name, which serves as your signature, in the field at the end of all the statements.

I hereby hold harmless Tides Canada Initiatives Society, in respect of its IndigenEYEZ project, its employees, officers and agents, and any facilitators of IndigenEYEZ from any and all responsibility and liability of any nature which may arise during the gathering, from circumstances beyond IndigenEYEZ control.I hereby hold harmless IndigenEYEZ, its employees, officers and agents, and any leaders of the IndigenEYEZ from any and all responsibility and liability of any nature which may arise if the named participant leaves the grounds of the program without authorization, or otherwise goes against the basic program guidelines listed above.Insurance: It is the responsibility of every individual to provide for their own accident and health coverage while participating in all IndigenEYEZ activities. I understand that neither IndigenEYEZ, Tides Canada Initiatives Society, nor Global Diversity Foundation provide any accident or health coverage for its participants.Participation: I acknowledge that I will be participating in activities, including field trips and potentially swimming, and will be transported in vans or private automobiles as authorized by IndigenEYEZ.Valuables: I understand that I should not bring cell phones, I-Pods, CD players headsets or other equipment to camp unless they are needed for travel. This includes electronic equipment, passports, money and any other valuables. I understand that I need to check in valuables with the camp manager at registration and that IndigenEYEZ cannot take responsibility for any missing valuables at Camp.Media Release: I give permission for IndigenEYEZ, a project of Tides Canada Initiative Society, or those who have the written consent of the IndigenEYEZ to use photos or videos of me for purposes of promoting future IndigenEYEZ programs. I expressly release Tides Canada Initiatives Society, in respect of its IndigenEYEZ project, your agents, employees, licensees, and assigns from any and all claims which I have or may have for invasion of privacy, defamation, or any other cause of action arising out of the use of these photographs and video.

Make sure you have selected EVERY statement above.

Travel

We encourage participants to carpool. Travel reimbursements may be available to those who connect with other youth coming from your Nation. Please contact Angela at angela@global-diversity.org for more information and application form.

Thank you for your application! We will be in touch soon.

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