Self Care & Art On The Land

Self Care & Art On The Land

June 22nd-23rd
There are two camps available, June 22nd and 22rd from 10am-8pm

Self Care & Art on the land is made for Indigenous youth to grow confidence in their skills, learn new artistic skills and grow their leadership skills. This program will take place in the greater Sudbury region for local Sudbury Indigenous youth and Indigenous youth from Manitoulin Island.

All Indigenous youth are welcomened in this space, however it is prioritized for disabled youth. Care has been taken to ensure the space is low impact and has space for low stimulation for varying needs. Please let us know your specific needs so we can make you as comfortable as possible.

This form covers all the information we'll need from you for your attendance. Your transportation and food will be covered and booked by us.

If you have any questions or need to provide additional information, there is a section at the end of this form to do so. Please contact Victoria at victoria@wemattercampaign.org for any other questions!
Contact Information
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
I am local to the greater Sudbury region or Manitoulin Island
*NOTE: this programming is eligible for participants from the great Sudbury region and Manitoulin Island
Valid Photo ID #1

Example: passport, drivers license or status card
Cancelof

Attendance Acknowledgements & Programming
I confirm if I am under 18 I am bringing a guardian over 18
*NOTE: anyone under 18 MUST be accompanied by someone over 18
Are you coming with a friend?
If so, what is their name?
*Best effort will be made to have you roomed close to each other
How comfortable are you with physical programming? For example: walks, swimming and yoga?

Child Care Accomodations

If you are bringing along your kids
Are you bringing any children
Child(ren) Information
Child's Name

First NameLast Name
Child's Birthday

MonthDayYear
Date
Child's Name

First NameLast Name
Child's Birthday

MonthDayYear
Date
Child's Name

First NameLast Name
Child's Birthday

MonthDayYear
Date
Support Person Information

If support person is attending
Name of support person

First NameLast Name
Email for support person
example@example.com
Support Person ID #1

Cancelof
Phone number for support person
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Information
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to emergency contact

Health & Medical Information
Do you use a mobility aid?
If yes please share which aids
This will not be shared with anyone and is just for our health records so we can ensure your safety in the event of an emergency and to ensure the camp is prepared for our activities together
The current plan is to have program participants arriving at 10am and leaving at 8pm. Does this day feel doable for you? Do you have any concerns about this?
Do you have any medical conditions we should be aware of? (e.g., allergies, chronic illnesses, etc.)
If you are currently taking any medications, please list them.
This will not be shared with anyone and is just for our health records so we can ensure your safety in the event of an emergency.
Do you have any allergies (medication, environmental, etc.)? If yes, please specify.
Do you require any special accommodations related to mobility, vision, or hearing?

Food Accommodations
Do you have any food allergies we should be aware of?
Do you require vegetarian or vegan meal options?
Do you require gluten-free meal options?
Are there any other dietary restrictions or preferences we should consider when planning meals?
Do you have any special requests or considerations regarding food and beverages?

Participant Agreements and Media Release
Waiver of Liability

I hereby release, discharge, and indemnify We Matter and all associated organizers of Wellness on the Land, including their Board of Directors, officers, employees, volunteers, agents, and insurers (collectively referred to as the “Released Parties”), from any and all claims, causes of action, and rights to compensation arising from: (1) damage to or loss of my property during my participation in the Project, (2) personal illness, injury, or medical/hospital care required during my involvement in the Project, and (3) any acts or omissions of the Released Parties before, during, or after the Project, except in cases of intentional misconduct.

I knowingly and willingly waive any such claims against the Released Parties, preserving only claims related to intentional misconduct. This Contract, Release, and Waiver of Liability shall remain binding and enforceable against me, my heirs, personal representatives, successors, and assigns pertaining to my participation in the project.
Signature

Media Release

I grant permission to We Matter and the organizers of the Hope Forum to capture and utilize photographs, digital images, videos, slides, and audio clips as necessary for promotional and public relations purposes. By participating in the Wellness on the Land programming, I consent to the organization's use of photographs, videos, and/or sound recordings in online platforms, media outlets, and materials created after the event for the purpose of promoting awareness of the event or for other life-affirming initiatives by the organizers.
Signature

Personal Conduct

I commit to showing respect towards fellow participants and the organizations involved. Recognizing that sensitive topics will be discussed during this gathering, I understand that any display of disrespectful or hurtful behaviour may result in my removal from the remainder programming. Furthermore, I agree not to attend while under the influence of drugs, alcohol, or illicit substances. By signing below, I acknowledge that I fully comprehend and consent to the conditions and expectations outlined above.
Signature
Should be Empty:

Contact Information