Re-Emerge Registration

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By completing this form you are registering to attend Re-Emerge camp in Cowichan Lake, BC from October 8-11, 2021.

Name of participant *

Parent or guardian name *

Parent/guardian permission *

I permit my youth to participate in Re-Emerge, 2021

I am 18 years old

Parent/guardian email *

Youth participant email *

Any other relevant email

Will there be anyone else who might need to know the details about camp packing lists, travel information or otherwise be in contact? Please provide any relevant email addresses.

Home phone or cell phone *

Address *

City and Province/State *

Country

Gender identification *

Female

Male

Non-binary

Other:

Preferred pronoun *

She/her

He/him

They/them

Other:

Date of birth *

Please note that youth must be between the ages of 14-19 at the time of attendance. We have expanded our age range to account for youth that have missed programs because of the pandemic.

YYYY

Ethnicity

School

Getting to camp

Please let us know how you are getting to camp, and whether you are able to offer a carpool spot to a youth in need.

Way to camp *

I have a vehicle and can offer a carpool

I have a vehicle but cannot offer a carpool

I am seeking a carpool option

Way from camp *

I have a vehicle and can offer a carpool

I have a vehicle but cannot offer a carpool

I am seeking a carpool option

If you can offer a carpool in either direction, how many seats are available?

Emergency contact and medical information

We have first-aid trained staff on site at camp, and emergency services available to us. Should anything happen during camp we will be in contact with the emergency contact person right away.

Emergency contact name, relationship and telephone number *

BC Care Card number (if applicable)

Medical Information, Allergies or Dietary Restrictions (write "none" if none) *

The spaces in our camps are limited. We require a deposit of $300 CDN to ensure availability.

Camp fees for our weekend camps are $500. We do not turn away any youth for lack of funds, and will always work hard to make sure we can find scholarships for those in need. If you require a partial scholarship please reach out to emily@powerofhope.ca

Payments can be made via credit card, cheque or e-transfer. We are more than willing to work with anyone who might not be in a position to attend. Please fill out our scholarship form and we will find a way to make it work.

Payment *

I will e-transfer my deposit to: emily@powerofhope.ca

I will pay my deposit by credit card: www/powerofhope.ca/register/pay

I will mail my deposit by cheque (address below)

I will fill out the financial assistance request form on the Power of Hope website

Please make cheques payable to Power of Hope

Please put participant's name on the memo line. Cheques can be mailed to:

Power of Hope Society
PO Box 23063 Cook Street PO
Victoria, BC V8V 4Z8
CANADA

Refund Policy

In the event of your cancellation before two weeks prior to the event, we will refund the entire amount paid.
* If you cancel with less than 2 weeks’ notice, your deposit is non-refundable, but we will refund the balance of your payment.
* If you do not show up, and have given no cancellation notice, we will make no refund.
* If you leave the program once it has started, we will not be able to refund any of the cost.

Please check the boxes below to give permission and show your understanding *

I give permission for my youth to participate in activities, field trips, and swimming and to be transported in vans or private automobiles as authorised by the Power of Hope

I hereby give consent for qualified Power of Hope first aid staff to administer appropriate medical attention to my youth if it becomes necessary.

I hereby hold harmless the Power of Hope, their employees, officers and agents, and any leaders of Power of Hope from any and all responsibility and liability of any nature which may arise during the gathering, from circumstances beyond our control.

I hereby hold harmless the Power of Hope, their employees, officers and agents, and any leaders of Power of Hope 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.

I understand that Power of Hope does not provide any accident or health coverage for participants.

I give permission and consent to Power of Hope to use photographs and other media of my youth for presentations and promotion of their programs. I understand that media is also used to document camp activities for future programming. (Or leave blank if you do not consent) If you would prefer not to be photographed, please let us know. We respect your right to opt out.

Valuables: We ask that youth do not bring cell phones, iPods or other equipment to camp unless they are needed for travel. Your youth will be asked to check any valuables in with the camp manager for safe keeping at registration. This includes electronic equipment, passports, money and any other valuables. Your youth will not need any money during camp. Power of Hope cannot take responsibility for any missing valuables at camp.

Required

Participant's consent to basic guidelines

Please make sure that the youth participant has read and understand the following agreements. The following non-negotiable guidelines have been established for participants of IndigenEYEZ and the Power of Hope’s gatherings in order to create a safe and respectful environment for everyone.

1. No leaving the program grounds without authorization

2. Check-in all valuables including money, electronic equipment, passports, etc. with the camp manager for safe keeping at registration

3. Refrain from using drugs or alcohol

4. No coupling/no sex

I agree *

I am agreeing to follow the guidelines above, and that not following them could result in my being sent home from the program.

Required

Covid-19 Guidelines

While at camp we must abide by the Covid guidelines set out by the BC government. In order for camp to be possible it is important that we respect and follow these guidelines. We want to make sure that we are behaving in a way that makes the most vulnerable people present feel comfortable and able to participate.

1. We will require that all youth and staff are vaccinated with at least one vaccine, and be symptom-free upon arrival including a contactless temperature read administered by us. If you are medically unable to be vaccinated we will require official documentation.
2. We will require masks to be worn indoors when in close proximity with others.
3. We will be eating far apart from one another.
4. The majority of our daytime programming will be outdoors, where we can be unmasked (if comfortable) and can move more freely.
5. We will defer to the comfort of the group. Meaning: if one person is not comfortable with touch or being unmasked around others, we will respect this and behave accordingly.
6. IF THERE IS AN INFECTION or if someone shows symptoms: We will quarantine that person and either bring them to get tested if possible, or have a family member come get them.

Please note: there is no perfect. We are open to your feedback if you feel these measures are not adequate - we will shift and change our procedures if we are able to. We also know that even if we do everything well there is still a possibility that things may go wrong. After camp, please limit your socialising to only those people within your home bubble, or get tested to be sure you are not a carrier before resuming normal activities.

*subject to change based on current BC official guidelines

I agree *

I agree to follow the Covid-19 guidelines as written above, and acknowledge that not doing so will result in my being asked to leave camp early.

Required

I understand that my typed electronic signature is valid in place of a written signature *

Yes

Required

Parent/Guardian signature (or youth if 18) *

Submit

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