Be Well Programme 2024

Be Well Programme - Retreat Registration

Friday 19 July - Sunday 21 July 2024

The Future Leaders ‘Be Well’ Programme aims to support the holistic health and well-being of Bermuda’s young people. We seek to respond directly to youth and community needs by encouraging wholesome fun which reinforces the importance of balance, good mental health and, ultimately, ‘being well’. The Be Well Programme will work toward sparking a commitment to emotional intelligence, mindfulness and reflection. In doing so, we cater more to the emotional needs of our youth, thereby supporting them in their future endeavors as they become our Future Leaders.

If accepted, a confirmation email will be sent with further information shortly thereafter.

NOTE ON REGISTRATION

Acceptance is not guaranteed.

Deadlines

Please register by 1 July 2024.

Applicant Information

Student's Name*

First NameLast Name

Sex:*

MaleFemale

Birth Date*

DayMonthYear

Current Age:*

T-Shirt Size

School/Occupation:*

Grade Level (2023-24 School Year)*

Address*

Street Address

Street Address Line 2

Parish

Postal CodeCountry

Parent/Guardian Information

Adult Name*

First NameLast Name

Relationship to child:*

Home Number*

Area CodePhone Number

Cell Number*

Area CodePhone Number

E-mail Address where you'd like to receive confirmation and information:*

Add a second E-mail Address (optional):

example@example.com

Emergency/Medical Information

Emergency Contact (Adult 2) Name:*

First NameLast Name

Relationship to child:*

Day Phone Number:*

Area CodePhone Number

Alt. Phone Number:*

Area CodePhone Number

Does the student have any allergies, chronic illness, medical conditions and or physical limitations? (If yes, please describe.)

Is the student prescribed an inhaler or any medications: (If yes, please explain any instructions)

Camping Stuff

Does the student have any dietary requirements or restrictions?

Does the student have any of the following items they could bring?

TentAir Mattress or Sleeping BagLaptop Device for Working/Typing

Is there anything you would be willing to contribute to the retreat? (Optional)

Eg Food, Supply, Camping Equipment, Monetary donation, Entertainment

Legal Stuff

Informed Consent and Acknowledgement

I, as the parent or legal guardian of the named student ('child'), do hereby grant permission for my child's participation in any and all activities prepared or facilitated by the Future Leaders Programme (the 'Programme'). In exchange for the acceptance of said child's candidacy by the Programme, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless the Programme and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected Programme sessions and activities. I understand that in the course of camping and engaging in recreational activities as part of the Programme, my child will undertake field trips which may include physical activity or the entering of environments to which they may or may not be normally accustomed. Every reasonable precaution will be taken to ensure my child's safety to the best of the ability of every staff member of the Programme.

I am fully aware, consent to, and accept these risks and voluntarily agree to allow my child's participation in all activities facilitated by the Programme.

Medical Release and Authorisation

As Parent and/or Guardian of the named student ('child'), I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is also granted to the Programme and its affiliates including Directors, Teachers, and Staff to provide the needed emergency treatment prior to my child’s admission to the medical facility. Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the safety of the named minor child, in my absence.

Photo Release

I furthermore understand that the photographs or videos of my child may be taken throughout the duration of the Programme. I grant permission without compensation that these photographs or videos may be used in publications, presentations, websites or promotion of the Programme.

Electronic Signature: By entering my name below, I accept the above conditions and releases. (You must be the legal parent or guardian of the child and 18 years old or over to sign.)*

First NameLast Name

Relationship to student (if not applicable, insert N/A):*

Current Date:*

DayMonthYear

Any additional comments or concerns you wish to add:

Optional

BY ACKNOWLEDGING AND CLICKING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

For questions or help, email info@futureleaders.bm .