Clone of STEAM Camp 2025

Indigenous STEAM Camp takes place at the Wii Chiiwaakanak Learning Centre, which is located at 511 Ellice Ave.

Camp dates:

Week 1 July 6 to 10
- Grades 1 to 6
Week 2 July 13 to 17
- Grades 4 to 6
Week 3 July 20 to 24
- Grades 3 to 8
Week 4 July 27 to 31
- Grades 3 to 8

Each day will run from 9:00 am to 3:30 pm.

There will be before care starting at 8:30 and after care until 4:30.

Full Name of Parent/Guardian*

First NameLast Name

Phone Number*

Format: (000) 000-0000.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

E-mail*

example@example.com

Child's Name*

First NameLast Name

Birth Date*

MonthDayYear

What grade will they be entering in Fall 2026?*

Gender*

Preferred Pronoun

He/himShe/herThey/themOther

Ethnicity Declaration*

School attended in 2025-2026 school year*

Does your child receive additional support at school ?*

YesNoI am not sure

To better understand the needs of your child, please describe the support. Example: only does half days at school, has an Individualized Learning Plan, IEP, etc.

All answers will help us to make the best experience for camp

If you are planning to attend with a family member or friend, please list them here.

Medical Conditions/ Dietary Restrictions (ie, any allergies, intolerances, diet preferences)

Please ensure that if your child carries an epi-pen that information is included above.

Emergency Contact (other than parent listed above)*

First NameLast Name

Emergency Contact #*

Format: (000) 000-0000.

Relationship*

Approved list of who may pick up your child. Please list first and last names of each individual.*

Unless prior arrangements have been made, the child will not be released to anyone who is not on this list. Identification may be required for those picking up the child. Please note that this list can be changed at any time. Please see staff to change your pick-up list.

Shirt size of participant*

Which camp session would be your first choice to attend?*

Week 1 - Grade 1 to 3 July 6 to 10Week 1 - Grade 4 to 6 July 6 to 10Week 2 - Grade 4 to 6 July 13 to 17Week 3 - Grade 3 to 5 July 20 to 24Week 3 - Grade 6 to 8 July 20 to 24Week 4 - Grade 3 to 5 July 27 to 31Week 4 - Grade 6 to 8 July 27 to 31

How did you hear about Indigenous STEAM Camp 2026*

From my schoolPast participantCommunity PosterOther

Photo Consent: I do hereby authorize the Wii Chiiwaakanak Learning Centre of The University of Winnipeg, to photograph, audio record, video record, podcast and/or webcast the child (digitally or otherwise) to showcase our programs/events without charge; and to allow Wii Chiiwaakanak Learning Centre to copy, modify and distribute in print and online, those images that include your child without having to seek further approval.

I give consent for Wii Chiiwaakanak to take photographs of me and/or my child(ren).*

YesNo

TO: THE UNIVERSITY OF WINNIPEG, as represented by WII CHIIWAAKANAK LEARNING CENTRE (“University”)
RE: COMMUNITY PROGRAM (“Program”)
INFORMED CONSENT, RISK ACKNOWLEDGEMENT AND INDEMNITY AGREEMENT

WARNING: By signing this document you indicate that you understand the risks associated with the Program, that you are aware that by allowing your child to participate in the Program on Campus, you are exposing him/her/them to the risks identified below. It gives the University authority to secure medical assistance for your child for which you agree to be financially responsible. You are agreeing to assume financial responsibility for any legal costs, payments or judgments made in favour of your child, as well as any damages to third persons or their property caused by your child.

Participation in the Program, carries certain inherent risks. I am aware that by allowing my child to participate in the Program, my child may be exposed to any manner of harm, injury, illness, death or property damage resulting from such risks, including but not limited to the following:

General Risks:

Loss or damage of personal property by any means including, but not limited to, theft, vandalism, fire, or water damage;
Travel by walking, motor vehicle, bus or any other means of transportation to, from, or during the Program;
Food Consumption: ensure your child is aware not to partake of drinks/food that may be provided during this Program if they have any food allergies; and
Loss, damage, injury, illness, death or expense that my child may, or that members of my child’s household(s) may suffer, including the contraction of a Communicable Disease as a result of my child’s participation in the Program. Communicable Diseases include, but are not limited to, any disease that can be transmitted from one person to another including viruses, bacteria, parasites or other organisms.

NOTE: Please consult with your child’s physician prior to them participating in any physical activity(ies) or using any equipment if they have any pre-existing conditions which may be affected by their participation in the activity(ies).

Activity(ies) Risks:

All manner of physical and neurological injuries;
Contact with participants or other people or sustaining injuries arising from their actions;
My child’s participation and/or use of equipment/materials beyond their own skills and abilities; and
The use, misuse, failure or malfunctioning of equipment/materials.

I have explained the risks associated with this activity to my child and he/she/they understand(s) the risks.

In consideration of the University allowing my child to participate in the Program, I agree as follows:

The University may administer first aid treatment to my child and may secure such medical advice and services as the University, in its sole discretion, may deem necessary for my child’s health and safety and I shall be financially responsible for such medical advice and services;
If circumstances arise in which the University, in its sole discretion, considers to be an emergency, I authorize the University to disclose any of my child’s personal medical, health or contact information, as the University deems reasonable;
I understand that it is my child’s responsibility to abide by the rules and regulations imposed on the participants by the University / Wii Chiiwaakanak Learning Centre and its Instructors and Volunteers. I have explained to my child the need to follow the instructions given by the Instructors and Volunteers;
I agree to HOLD HARMLESS AND INDEMNIFY the University, its Board of Regents, officers, employees, students, agents, representatives, members, volunteers and independent contractors, from any and all liability for the following:
- any legal costs or payments made pursuant to a settlement or trial judgment in favour of my child and in relation to my child’s participation in the Program; and
- any damages to the property of, or personal injury to, any third party, resulting from my child’s participation in the Program.
I agree that this Agreement shall be governed by and construed in accordance with the laws in force in the province of Manitoba and the federal laws of Canada, as applicable, and that the courts of Manitoba shall have exclusive jurisdiction over all claims, disputes and actions arising out of or related to my child’s participation in the Program, and this Agreement.

In entering into this Agreement, I confirm that I am not relying upon any oral or written representations or statements made by the University other than what is set forth in this Agreement.

I consent to my child’s personal information being collected under The University of Winnipeg Act (Manitoba) and 36(1)(b) of The Freedom of Information and Protection of Privacy Act (Manitoba) for the purposes set out herein. I understand that I may contact the University’s Wii Chiiwaakanak Learning Centre, 511 Ellice Ave, Winnipeg, MB, R3B 2E9, wiichii@uwinnipeg.ca, or to 204.258.2951 with any questions regarding privacy.

I CERTIFY THAT I AM THE PARENT AND/OR LEGAL GUARDIAN OF MY CHILD.

I CONFIRM THAT I HAVE READ AND UNDERSTOOD THIS AGREEMENT AND THAT I AM AWARE THAT BY SIGNING THIS AGREEMENT I AM ACCEPTING FINANCIAL RESPONSIBILITY FOR ANY MEDICAL ASSISTANCE THE UNIVERSITY MAY DEEM NECESSARY FOR MY CHILD’S HEALTH AND SAFETY, FOR ANY LEGAL COSTS, PAYMENTS OR JUDGMENTS MADE IN FAVOUR OF MY CHILD AND FOR DAMAGE TO THIRD PERSONS OR THEIR PROPERTY THAT MY CHILD MAY CAUSE.

I agree to the above terms*

Yes, I agree

Signature

Any additional notes that you'd like to share

Indigenous STEAM Camp Registration 2026

Child's Information:

Camp Information

Informed Consent