16th Annual Regional Youth Gathering Theme- Economic Development “Building Our Paths Ahead”

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

WHO SHOULD ATTEND?
The Gathering is for First Nations youth between the ages of 15 to 30 years from the Manitoba Region who are interested in the theme “Building Our Paths Ahead”. Some of the workshops will also focus on leadership, various economic development opportunities, environment, housing and other topics. There is no registration fee but, in order to attend, registration is required. Accommodations will be provided for those registered and based on availability.
**Participants under the age of 18 years will require a chaperone**

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;

200-275 Portage Avenue
Please only send the application form back and not the information, this is yours to keep. **All applicants will be contacted via telephone or by email **

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**All information is to be filled out completely, it is mandatory for your application to be accepted**

16th Annual Regional Youth Gathering Registration Form
Date: Tuesday, February 19th to Thursday, February 21st, 2013
(Travel dates: Monday, February 18th and Friday, February 22nd, 2013 *Please note: For fly-in communities travel dates may differ.)

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.): _________________________

Roles & Responsibilities of Youth Delegates
Please read and review the responsibilities of Youth Delegates, sign and date to indicate your commitment:
 I must attend all three days of the 16th Annual Regional Youth Gathering.  I must be punctual for all daily sessions, with the understanding that meals and health breaks will be scheduled in at appropriate times.  I will abstain from the use of alcohol and drugs while representing my community as a youth delegate throughout all three days of the gathering.  I will make a strong effort to actively participate in all discussions, group activities and leisure activities.  I will respect the hotel and conference centre rules. If I damage any property or smoke in a nondesignated area, I will be required to pay for the costs at my own expense.  I understand that failure to uphold my commitment as a youth delegate, my participation in the gathering may be terminated as decided by the host organizations The Assembly of Manitoba Chiefs Youth Secretariat. Delegates will be sent home at their own expense.

____________________________ Signature of Delegate
IN CASE OF EMERGENCY

_________________________ Date

Name (Relationship): ___________________________ Phone: (_____) _____-__________
MEDICAL INFORMATION

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.

If needing transportation, which applies to you?
From: Thompson, Manitoba

From: Portage la Prairie, Manitoba * Please list pick up site: ___________________________________________________________________

___________________________ Signature of Delegate

_________________________ Date

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MEDIA RELEASE FORM
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. ____________________________ Signature of Delegate _________________________ Date

Parent/Guardian Media Release Form (if under 18 years of age, please get parent/guardian to sign)

I, ________________________, hereby grant permission to the Assembly of Manitoba Chiefs Youth
(Name)

Secretariat, to use my child’s 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.

______________________________ Signature of Parent/Guardian

_____________________ Date

** Please leave all valuables at home **

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.

___________________________ Signature of Delegate

_________________________ Date

____________________________ Signature of Parent (If required)

_________________________ Date

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**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):_____________

Parent/Guardian Authorization (If delegate is under the age of 18 years):
I, parent/ guardian of _______________________, grant permission for my child to attend this five
(Delegate’s Name)

day youth gathering under the supervision of __________________________.
(Chaperone’s Name)

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

Roles & Responsibilities of Chaperones:
Please read and review the responsibilities of chaperones, sign and date to indicate your commitment:
 I must attend all three days of the 16th Annual Regional Youth Gathering.  I must be punctual along with the delegate(s) I am chaperoning for all daily sessions, with the understanding that meals and health breaks will be scheduled in at appropriate times.  I will abstain from the use of alcohol and drugs while representing my community as a Chaperone throughout all three days of the gathering.  I will respect the hotel and conference centre rules. If I damage any property or smoke in a nondesignated area, I will be required to pay for the costs at my own expense.  I understand that failure to uphold my commitment as a chaperone, my participation in the gathering may be terminated as decided by the host organizations The Assembly of Manitoba Chiefs Youth Secretariat. Chaperones will be sent home at their own expense. (Please sign and date, it is mandatory for your application to be accepted)

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.

_____________________________ Signature of Chaperone

_____________________ Date

** Please leave all valuables at home **

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.

______________________________ Signature of Chaperone

_____________________ Date

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