Youth Intake

Youth information

First Name*
First
Last name*
Last
Date of birth*
MM slash DD slash YYYY
Gender*
Alberta Health Care number*
Treaty number*
Allergies
EpiPens must be provided for youth with allergies.
Major injuries or medical conditions that may prohibit you from participating in activities
Parent or legal guardian information
First name*
First
Last name*
Last
Phone*
Email*
Emergency contact information
This information must be provided before youth are allowed to participate in any Sekweha daily programming or trips.
Emergency contact 1
Name
First
Relation
Phone
Emergency contact 2
Name
First
Relation
Phone
Photo and video permission
I authorize Janvier Sekweha Youth Centre to use my name, image or video in internal or external corporate media, including publications and websites. The photographs may be used until December 31, 2022. I may revoke my permission prior to this date upon reasonable notice in writing.
Confirm*
- Confirm
Confirm permission
Youth behaviour
Sekweha will not tolerate bad behaviour within the Youth Centre or at any function outside of Sekweha.
1. First warning! Youth is not allowed at the centre for the rest of the day.
2. Second warning! Parent/guardian is contacted. Youth is not allowed at the centre for a week and must meet with the Sekweha Manager before returning.
3. Third warning! Parent/guardian is contacted. Youth is not allowed at the centre until parent(s) and youth meet with the Sekweha Manager.
I understand that program activities are done in groups, and that all participants are expected to participate fully and behave in an appropriate manner. Continuous disruptive behaviour, which affects the experience or compromises the safety of others, will result in the participant being sent home. I agree to bear any additional expenses associated with this.
I understand*
- I understand
I understand

Walk in two worlds

Youth information

Parent or legal guardian information

Emergency contact information

Photo and video permission

Youth behaviour

If you have questions, please don’t hesitate to contact us. We’d love to help.