Youth Program

Welcome to the SȾÁUTW̱ Youth Program! We support youth aged 12-18 from our community, with about 40 participants each year. Our program runs after school during the school year and offers summer and spring break camps. Activities include learning about our culture, arts and crafts like regalia making, bone game set creation, and cedar stripping. Youth interact with Elders, and work with different departments like Fisheries, Lands and Wellness departments. We enjoy day trips, fundraisers, and other engaging activities. Join us to celebrate our heritage and empower our young people. Please register if you are interested in participating. Open to registered SȾÁUTW̱ youth and youth in the community.

CONTACT

YOUTH COORDINATOR
EMMA WINTER PELKEY
(250) 652-9101
youthcoordinator@tsawout.ca

HOURS

Monday – Friday
3:00 pm – 6:00 pm

"*" indicates required fields

Step 1 of 7

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YOUTH REGISTRATION INFORMATION

Please complete the following fields for each youth

Additional Student Information

Name	Birthdate	Medical Number	Status Number	Actions

There are no Youth.

Maximum number of youth reached.

PICK-UP INFORMATION

Youth Room Hours: Monday - Friday from 3:00 pm - 6:00 pm
Please keep in mind hours may fluctuate. We will inform the youth of schedule changes ahead of time.

Youth will be:*

Select if your child(ren) will be picked up, walked home or both.

Picked Up

Walked Home

Youth will be picked up:*

Enter time your child(ren) will be picked up by (must before 4:00 pm)

Name of Person Picking Up*

First Last

Phone Number of Person Picking Up*

Name of Person Walking Home*

First Last

Phone Number of Person Walking Home*

PARENT / LEGAL GUARDIAN INFORMATION

Name*

First Last

Address*

Street Address Address Line 2 City Province Postal Code

Home Phone

Work/Cell Phone*

Email*

EMERGENCY CONTACT

List two people we can contact who can take responsibility if you are not available.

Emergency Contact 1*

First Last

Phone*

Emergency Contact 2*

First Last

Phone*

CONSENT FOR PHOTO AND INTERNET USE

Parent Consent for Photographs*

I give permission for the Tsawout SȾÁUTW̱ Youth Program to photograph my child(ren) and use the photographs for media purposes.

Yes

Parent / Legal Guardian Initial*

Parent Consent for Internet Use*

I give permission for my child/ren to access the internet at the SȾÁUTW̱ Youth Program.

Yes

Parent / Legal Guardian Initial*

WAIVER

By checking this box, you are confirming your signature.*

By giving permission for my child/ren to participate in the SȾÁUTW̱ Youth Program events, workshops and gatherings and Tsawout’s Swim Clubs, I recognize that in the event that my child/ren become become injured, I agree to indemnify and hold Tsawout First Nation, and their staff and volunteers harmless from and against any claim for damages, including any claim based on the alleged negligence of said parties, that arise from an injury, accident, or harm of any kind to the registered child/ren while participating in any of the Tsawout SȾÁUTW̱ Youth activities, or any other supervised event.

I agree

AUTHORIZATION TO TREAT A MINOR

Consent*

I, the undersigned parent or legal guardian/s of the participant/s named, do hereby authorize and consent to any medical attention for the child/ren in case all efforts have fails to contact me:

Name of Doctor*

Doctor Phone*

RECREATION PROGRAM AND FIELD TRIP ACTIVITIES - Behaviour Contract

By checking this box, you are confirming your signature.*

I agree

BEHAVIOUR CONTRACT
This Behaviour contract is drawn up by the the SȾÁUTW̱ Youth Program with the intent of managing a fun and safe learning environment for all children and employees who attend and must be signed by both the child and his/her parent or guardian.

- The contract requires the students to maintain respectful, responsible and cooperative behavior during their attendance at the the SȾÁUTW̱ Youth Program and when engaging in organized activities and field trips.
- The contract requires the student to be safe and to remain with supervisors and within the facilities during program hours and outings.

The accepted rules and procedures that were developed by the students of the the Tsawout SȾÁUTW̱ Youth Program are posted within the classrooms. These rules apply to all students entering the the Tsawout SȾÁUTW̱ Youth Program.
Students who participate in a respectful, responsible, cooperative and safe manner and follow the rules set forth for each day, will be recognized and rewarded.
Students who choose to behave disrespectfully and in an unsafe manner will be dismissed for an agreed period of time from the Tsawout SȾÁUTW̱ Youth Program.

YOUTH ROOM STRIKE SYSTEM

By checking box, parent acknowledges reading Strike System*

I agree

Please be advised the SȾÁUTW̱ Youth Summer Camp participants and staff will abide by these rules set forth to help keep the children safe
1. NO BULLYING, FIGHTING OR SWEARING
2. Be Respectful of yourself, others, and all public property
3. Be Cooperative with ALL Staff and Youth Leaders
4. ALWAYS Ask your Leader....before leaving your group, ONLY with your Buddy
5. Use Road Safety: Walk on side of road/sidewalk, behind your leader
6. No eating/No drinking on the Bus
In accordance with these rules, staffs have established a “Strike System.” If a camper is “Not LISTENING” and must be spoken to, it will equal 1 strike, (up to 3 strikes/day).
* 3 STRIKES = 1 Day Suspension on the next camp day from Tsawout Youth Program
* 3 more STRIKES (Totals 6 Strikes) = 1 Week suspension from Tsawout Youth Program
*3 more STRIKES (Totals 9 Strikes) = Dismissal from Tsawout Youth Program
Thank you very much for reviewing these expectations with your child/ren and please do not hesitate to contact us if you have any questions or concerns.

Confirmation

Signature*

By signing this registration form, I agree to all the conditions within. I declare this information is true and accurate, to the best of my knowledge.

Today's Date*

MM slash DD slash YYYY

Youth Program Registration

Youth Program

CONTACT

HOURS

YOUTH REGISTRATION INFORMATION

PICK-UP INFORMATION

PARENT / LEGAL GUARDIAN INFORMATION

EMERGENCY CONTACT

CONSENT FOR PHOTO AND INTERNET USE

WAIVER

AUTHORIZATION TO TREAT A MINOR

RECREATION PROGRAM AND FIELD TRIP ACTIVITIES - Behaviour Contract

YOUTH ROOM STRIKE SYSTEM

Confirmation