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To: Manitoba First Nations Youth From: Assembly of Manitoba Chiefs Youth Secretariat Subject: 16th Annual Regional Youth Gathering The 16th Annual Regional Youth Gathering is presented by the Manitoba First Nations Youth Council and the Assembly of Manitoba Chiefs Youth Secretariat.
WHEN? WHERE?
Tuesday, February 19th to Thursday, February 21st, 2013 Sagkeeng First Nation- Sagkeeng Mino Pimatiziwin Family Treatment Centre
REGISTRATION INFORMATION:
Transportation will be offered to and from Sagkeeng from two destinations: o Thompson, Manitoba (Depending on the number of people, a chartered bus or another type of transportation will depart from this location) o Portage la Prairie, Manitoba (A chartered bus)
Departure to Sagkeeng First Nation, Manitoba: Monday, February 18th, 2013 Transportation from Thompson, Manitoba will contact individuals Chartered bus leaves from Portage la Prairie, Manitoba: Monday, February 18th, 2013 @ 2:00 pm
(Portage la Prairie- Winnipeg Brokenhead Sagkeeng)
Return to Thompson, Manitoba and Portage la Prairie, Manitoba: Friday, February 22nd, 2013 Transportation will leave from Sagkeeng First Nation Nation @ 9:00 am (Same
route will be used as departure site)
For all other destinations along the way, a pick-up point will be coordinated with all participants taking the transportation offered by the Youth Secretariat. Contact will be made to confirm pickup point and time. 1
Meals will be provided on-site in Sagkeeng First Nation, Manitoba. Participants are strongly encouraged to bring money for meals or their own snacks for the ride. Delegates are responsible for their own transportation to and from Sagkeeng First Nation, Manitoba if they choose not to get on the chartered bus offered by the Youth Secretariat. We aim to have two First Nation representatives from each First Nation community. *Please note this may change and is dependent upon logistics. **If you are from a fly-in community, the Youth Secretariat will contact you directly to make arrangements as they may differ. ** Deadline: Wednesday February 13, 2013
For the more information please contact: Assembly of Manitoba Chiefs Youth Secretariat 200 275 Portage Avenue Winnipeg, MB R3C 2B3 Main Tel: 1(204) 956 - 0610 Toll Free 1 (888) 324 5483 Fax: (204) 956-2109 COMPLETED REGISTRATIONS FORMS CAN BE FAXED TO:
Attention: Youth Secretariat 16th Annual Regional Youth Gathering Fax Number: 1-204-956-2109
Or: Scanned to;
ccochrane@manitobachiefs.com
Or: Dropped off at the following location;
**All information is to be filled out completely, it is mandatory for your application to be accepted**
Location: Sagkeeng First Nation, Manitoba Application Deadline: Wednesday February 13, 2013
DELEGATE INFORMATION
First Name: __________________________ Last Name:_________________________ ______ Age: __________ Gender (Please circle): Male Female Address: ________________________________________________
City/Community: __________________________ Province: __________ Postal Code: ____________________ Phone: (_____) _______-_________ E-mail:_______________________________________________________ Tribal Nation (Cree, Dakota, Dene, Ojibway, Oji-Cree, etc.): _________________________
_________________________ Date
Do you have any food/medical allergies or medical conditions that we should be aware of? _____________________________________________________________________________________ _____________________________________________________________________________________ 3
** Please have medical information with you or bring your health card on-site. **
PLEASE ANSWER THE FOLLOWING QUESTIONS:
Is this your first time attending the Regional Youth Gathering? If not, when did you attend? _____________________________________________________________________________________ What do you hope to gain from of the Regional Youth Gathering? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ How did you hear about the Regional Youth Gathering? (Please circle which applies)
Newspaper Radio Facebook Family Friend Other ________
TRANSPORTATION
Which option(s) applies to you? (Please circle which applies)
Need Transportation Own Personal Arrangement Fly- in community
* Please note that travel is not provided for personal travel arrangements, i.e. personal vehicles. All travel must be arranged through Youth Secretariat to be covered.
_________________________ Date
Youth Secretariat, to use my photograph/ or record myself, my person and/or voice on still or motion picture film and/or audio tape, and to use said material to promote the Assembly of Manitoba Chiefs Youth Secretariat through the media of television, film, radio, print, or other electronic media. I further waive any claim to remuneration for use of audio-visual material recorded for this purpose, and I understand that this material remains the property of the Assembly of Manitoba Chiefs Youth Secretariat. ____________________________ Signature of Delegate _________________________ Date
Parent/Guardian Media Release Form (if under 18 years of age, please get parent/guardian to sign)
Secretariat, to use my childs photograph/ or record themselves, their person and/or voice on still or motion picture film and/or audio tape, and to use said material to promote the Assembly of Manitoba Chiefs Youth Secretariat through the media of television, film, radio, print, or other electronic media. I further waive any claim to remuneration for use of audio-visual material recorded for this purpose, and I understand that this material remains the property of the Assembly of Manitoba Chiefs Youth Secretariat.
_____________________ Date
LIABILITY WAIVER
We at the Assembly of Manitoba Chiefs Youth Secretariat are not responsible for the loss or theft of property during the 16th Annual Regional Youth Gathering; also we are not responsible for any injury resulting from participation in activities held during the Regional Youth Gathering. If medical attention is needed for any reason, we the Assembly of Manitoba Chiefs Youth Secretariat will be required to take the participant to the closest medical facility available.
_________________________ Date
_________________________ Date
**CHAPERONES MUST ACCOMPANY INDIVIDUALS WHO ARE UNDER THE AGE OF 18 YEARS**
CHAPERONE INFORMATION
**CHAPERONE MUST BE 23 YEARS OF AGE OR OVER, YOUTH SECRETARIAT POLICY** First Name: _____________________ Last Name: ___________________________ Age: _________ Gender (Circle one): Male Female
Transportation: __________________ (Indicate if are using Transportation provided or own transportation) Address: ___________________________________ City/Community: _________________________ Province: ___________ Postal Code: _____________ Phone: (____) _____________________ Fax: (____) _________________________
Email: _______________________________________
Relation to Delegate: (circle one) Parent/Guardian Sister/Brother Cousin Other (Please specify):_____________
I understand that the Assembly of Manitoba Chiefs Youth Secretariat assumes no responsibility for any injuries, lost or stolen property due to any action, behaviors, or decisions made by my child. __________________________ Signature of Parent _________________________ Date
I understand and fully accept the statement(s): ___________________________ Signature of Chaperone _________________________ Date 6
MEDIA RELEASE
I, _________________________, hereby grant permission to the Assembly of Manitoba Chiefs
(Name)
Youth Secretariat, to use my photograph/ or record myself, my person and/or voice on still or motion picture film and/or audio tape, and to use said material to promote the Assembly of Manitoba Chiefs Youth Secretariat through the media of television, film, radio, print, or other electronic media. I further waive any claim to remuneration for use of audio-visual material recorded for this purpose, and I understand that this material remains the property of the Assembly of Manitoba Chiefs Youth Secretariat.
_____________________ Date
LIABILITY WAIVER
We at the Assembly of Manitoba Chiefs Youth Secretariat are not responsible for the loss or theft of property during the 16th Annual Regional Youth Gathering; also we are not responsible for any injury resulting from participation in activities held during the Regional Youth Gathering. If medical attention is needed for any reason, we the Assembly of Manitoba Chiefs Youth Secretariat will be required to take the participant to the closest medical facility available.
_____________________ Date