1 CHAMPAGNE and AISHIHIK First Nations Dunèna Kenàdän Kekwänìdlį Where children are Learning, Being Active and Having Fun!!!!!!! Promoting self-reliance 2015 Summer Camp Registration Form Elementary youth camp ages 9-12 August 11-14 & August 18-24 Aishihik biking trip Full Legal Name of participant: __________________________________________________________ Name of Parents/Guardians: 1._________________________________________________________ 2._________________________________________________________ Address: __________________________________________________ __________________________________________________________ Home Phone: _________________Cell Phone: __________________ E-mail address (mandatory) __________________________________________________________ ADDITIONAL EMERGENCY CONTACT INFORMATION: 1. Name: _______________________________________________ Relation to Participant: _________________________________ Phone Number: ___________Additional Phone: ____________ 2. Name : _______________________________________________ Relation to Participant: _________________________________ Phone Number: ___________Additional Phone: ____________
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CHAMPAGNE and AISHIHIK First Nations
Dunèna Kenàdän Kekwänìdlį
Where children are Learning, Being Active and Having Fun!!!!!!!
RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT.
BY SIGNING THIS DOCUMENT YOU WILL WAIVER CERTAIN LEGAL RIGHTS. PLEASE READ THIS DOCUMENT CAREFULLY.
FULL LEGAL NAME: ______________________________________________________________________________ ADDRESS: ____________________________________________________________________ POSTAL CODE: _________________CITY/TOWN/VILLAGE: ________________________ PROVINCE/TERRITORY: ________________ ASSUMPTION OF RISK: I AM AWARE THAT BY HAVING MY CHILD(REN) PARTICIPATING IN THE , “Dunèna
Kenàdän Kekwänìdlį” also known as “Where children are Learning, Being Active and Having Fun summer camp” LEAVING and/or attend an event in either Haines Junction/Takhini/Whitehorse/Shadhala/Canyon/Klukshu/Pine Lake/Kathleen Lake/Dezadeash River/Squirrel Creek/Hutshi/Aishihik/ MAY INVOLVE RISK AND OTHER UNFORSEEN HAZARDS. I FREELY ACCEPT AND FULLY ASSUME ALL SUCH RISKS AND OTHER DANGERS AND HAZARDS AND THE POSSIBILITY OF; PERSONAL INJURY, DEATH, PROPERTY DAMAGE, AND OTHER LOSS RESULTING THEREFROM. REALEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT In consideration of the CHAMPAGNE AND ASHIHIK FIRST NATION accepting my child’s application for my child’s participation in the “Dunèna Kenàdän Kekwänìdlį” also known as “Where
children are Learning, Being Active and Having Fun summer camp” permitting my child’s use of its facilities (hereby thereafter as the “Dunèna Kenàdän Kekwänìdlį” also known as “Where children
are Learning, Being Active and Having Fun summer camp”) I hereby agree to the following: 1. TO WAIVER ANY AND ALL CLAIMS THAT I HAVE OR MAY IN THE FUTURE
AGAINST THE CHAMPAGNE AND AISHIHIK FIRST NATION and its respective
directors, officers, employees, agents representative, (all of whom are hereinafter collectively
referred to as “THE RELEASEES”) and to RELEASE THE RELEASEES from and all
liability for any loss, damage, injury, or expense that my child may suffer, or that my child
may suffer as a result of my child’s use of the equipment due to any cause whatsoever,
INCLUDING NEGLIGENCE, BREACH OF CONTRACT, OR BREACH OF ANY
STATUTORY OR OTHER DUTY OF CARE, INCLUDING AY DUTY OF CARE.
2. TO HOLD HARMLESSAND INDEMNIFY THE REALEASEES from any and all
liability for any damage to property of, or personal injury to, any third party, resulting from
my child’s use of or presence during the trip.
3. This agreement shall be effective and binding upon heirs, next of kin, executors,
administrators, assigns and representative, in the event of my death or incapacity.
4. This agreement shall be governed by and interpreted in accordance with the laws of the
Yukon Territory.
5. Any litigation involving the parties to this Agreement shall be brought within the Yukon
Territory.
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In entering into this Agreement I am not relying upon any oral or written representations or statements made by the RELEASEES other than what is set forth in this Agreement. I HAVE READ AND UNDERSTOOD THIS AGREEMENT AND I AM AWARE THAT BY SIGNING THIS AGREEMENT I AM WAIVING CERTAIN LEGAL RIGHTS WHICH MY CHILD OR MY HEAIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS ASSIGNS AND REPRESENTATIVES MAY HAVE AGAINST THE RELEASEES.
Singed this _____day of ________________________2015 Full Legal name of Child: ______________________________________________ __________________________________________________________________ Signature of parent /guardian __________________________________________________________________ Print name of Parent/guardian __________________________________________________________________ Signature of Witness __________________________________________________________________ Print name of Witness
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Yahoo you are registering for the Elementary
youth camp!!!!!!!!
Keep this information sheet with your parents/guardians
or stick it to your fridge so that you do not forget
anything!
In the morning those in Whitehorse will be picked up at
the main CAFN office. If you are being picked up in
Haines Junction you will need to have all of your gear
at the youth center. We will be doing a gear check as
the first night of camp with the youth.
Students also need to bring a small snack and a lunch
for the first day of camp August 18.
Youth MUST have a proper biking helmet and proper bike
for the trip. We recommend mountain bikes for the
trip. “trick” bikes i.e. BMX bikes are not allowed.
We have attached a list of all the things you are going
to need for the camp. Please make sure you bring
everything you need.
Parents and guardians are asked to check their e-mail
on a regular basis as CAFN Education staff will be
sending an update via e-mail about the camp. This e-
mail will include location of campers and camp updates.
On the first day of camp all youth must share with the
group ONE or more positive ways that he/she will do to
help out at camp (i.e. helping with dishes, cleaning up
garbage, helping others pack etc…).
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Daily Agenda Please keep this copy
Tuesday August 11 Whse youth depart for Shädhäla from main CAFN office at 4.30 pm HJ youth depart for Shädhäla from youth center at 4.30 pm Overnight at Shädhäla Kų Wednesday August 12 Depart Shädhäla for Mush Lake Overnight bike trip to Mush Lake Night activities with Parks Canada Thursday August 13 Depart Mush Lake for Kathleen Lake Overnight at Kathleen Lake Campground Friday August 14 Depart Kathleen Lake Campground Whse youth dropped off at Main CAFN office at 3 pm HJ youth dropped off at youth center at 1 pm Tuesday August 18 10 am depart for Aishihik Lake Campground Overnight at Aishihik Lake Campground Wednesday August 19 Bike to second camp location on Aishihik road Thursday August 20 Bike to third camp location on Aishihik Road Friday August 21 Arrive at Aishihik Village Saturday August 22
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All day harvesting activities in Aishihik Village Sunday August 23 All day harvesting activities in Aishihik Village Monday August 24 Depart Aishihik Village for home and drop off by 5 pm
When we are finished the bike trip, pick up for Whitehorse students will be at the main CAFN office in Whitehorse and parents can pick up for Haines Junction students at the youth center. The camp coordinators will also be phoning CAFN on a daily basis with a satellite phone to make sure parents are informed of location of the group. An update e-mail will be sent to parents/guardians
If you have any questions/comments/concerns please call or e-mail Luke Campbell 867-336-3283 [email protected] Or Jenifer Chambers 867-689-5380 [email protected]
Contact numbers during camp Shädhäla kų (Champagne Hall) 867-634-2336
CAFN Education 867-456-6888 HJ Youth Center 867-634-2012
o Socks x 5 o Underwear x 5 o T-shirt x 3 o Pants x 2 (avoid jeans) o Swimsuit o Warm sweater o Rain pants and rain jacket o Toque o Biking gloves o Neoprene water shoes o Proper shoes for biking (no open toed
shoes) o Pajamas o Biking shorts
Please try to avoid bringing cotton clothing as these take a long time to dry. We recommend bringing polyblends, wool and other synthetic clothing When packing your clothing remember that some of your clothes may get torn or wrecked while we are in the bush.
Personal items
o helmet (mandatory) o Toothbrush/toothpaste in small ziplock
bag o Lip balm o Sun Screen o EPI-PEN o Personal & Allergy Medication o Sunglasses o Deodorant o Towel (dark in color, fast drying) o Face cloth (dark in color, fast drying) o Leatherman (must be in a case) o Water bottle (heavy duty, no glass) o sleeping bag (must be lightweight) o Pillow case (do not bring a pillow) o Sandwich container that will not leak o Bear bell o biking backpack o plate/bowl (camping style) o Biodegradable shampoo/conditioner o Biodegradable hand soap
If you have a “Seal Line storm pack“ to store your gear in please bring it as the chances of gear getting wet are very high. Don’t forget you enthusiasm!!!!!!!
Do not bring the following to the camp:
o Valuables o Any non- prescription illegal Drugs o Any electronics (IPods, MP3, cell phones, video games, tablets etc) o Make- up o Fragrance products (cologne, perfume etc) o Alcohol o Bear spray/bear bangers o weapons
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Please check the equipment list on this registration form. If you do not have all the
equipment listed C/A may be able to provide to lend students some items.
Do you have all the equipment needed for the camp? _____Yes _____No
If you have marked NO, please list the equipment your child will need in order to
participate in the camp (If you need supplies you need to hand this sheet to Luke
