Learn to Shred/Shred More Application Package

Learn to Shred/Shred More Application Package

Please fill out all sections below
For a printable/downloadable version of this application click here!
Application Form

*** Youth must be at least 12 years old by start of program to apply for this program.

**See our Privacy Policy for details on how we manage your information. We never share or sell your information.

*Our Terms and Conditions can be found HERE for your reference

Program Dates:

Learn to Shred is split into 3 groups, to see dates for each group click here
Full name of applicant*

First NameLast Name
Age (as of start of program)*
Applicant's Pronouns (select those that apply):*

She/HerHe/HimThey/ThemPrefer Not to AnswerOther
Referral source? How did you hear about us?*
Place of Residence*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you identify as an individual within the BIPOC community? - All information will be kept confidential in accordance with federal law and does not affect your eligibility for our programs, we collect this information to provide participant demographics to our funders.*

YesNoPrefer not to answer
If you answered 'yes' to the previous question, please select from list below:
Are you a first time snowboarder?*
If you responded 'No' to the previous question, please tell us how many days of experience you have and how long ago.
Will this be your first time participating in our 'Learn to Shred' program or are you applying for 'Shred More' ('Shred More' is for your who have already completed our 'Learn to Shred' program and priority for 'Shred More' is given to older youth and youth with positive attitude and attendance during Learn to Shred). *
In your own words, please explain why you would like to participate in our 'Learn to Shred' program.*
Can you be available for one weekday evening (either Wed or Thurs) and one Sunday a week for 4 weeks during the months of Jan/Feb/March?*
Please list any previously known conflicts with the above schedule:*
RENTAL INFORMATION: Please enter youth's height, weight, shirt and shoe size (for supply and rental purposes):*
Parent/Guardian Email Address (this is where we will send notice of acceptance into the program and program information once accepted)*
example@example.com
PICK UP LOCATION: Are you able to meet at one of our central pick-up locations - West Kelowna Xtreme Theatre parking lot (beside Dairy Queen), Orchard Park Mall (beside bus loop), Rutland Shell (Hwy 33 and Gerstmar), or Rutland 7-11 (Hwy 33 and Rutland Rd) for transport to the mountain?*
TYPE OF SPOT: Please indicate the type of spot you are applying for:*

Paid ($750/participant - invoice will be sent once participant has been accepted into the program)Scholarship (Free for eligible youth - please select from eligibility criteria below)Partial (if you do not meet any of our eligibility requirement for a full scholarship (listed below) but would like to inquire about partial support, please select this option and we will follow up with you to discuss options)
Please see eligibilty criteria below

If selecting eligibility criteria that requires documentation/proof of eligibility, please email 1 document to confirm eligibility to Programs@elevationoutdoors.ca (if you've selected multiple criteria that apply, you do not need to send documention for every one, choose the one that is easiest to provide).

To see the current Low Income Cut-Offs (LICO), click here and scroll down to 'Who We Serve'.
If you selected "Scholarship" for TYPE OF SPOT above, please select all that apply.

Parent/guardian or the youth are receiving social assistance *Proof of assistance requiredThe youth is involved with MCFD programs or is in foster care *Letter from social worker requiredThe youth is on parole, probation, or in a restorative justice program *Letter from office/case worker requiredThe youth is connected to a mental health clinician or practitioner *Letter from mental health worker required*The youth identifies as Indigenous (or Metis, First Nations, etc. - no proof necessary)Parent/Guardian living with the participant has income at or below the Low Income Cut-Offs *Proof of income requiredI do not meet any of these criteria, but still face financial barriers. I would like to be contacted about a Partial Scholarship.
GOOGLE CALENDAR SHARING AND JUMPSTART PERMISSION:

Elevation Outdoors has permission to share Google Cal dates with my and/or my child's email adress (leave blank below if not interested).
Parent/Guardian Email Address
example@example.com
Youth's Email Address
example@example.com
I give permission to Elevation Outdoors to contact me about future programs and opportunities that come available.*
I give permission for Elevation Outdoors to provide my contact information to the Canadian Tire Jumpstart Foundation. As partial funders for this program they like to be able to contact you directly with future opportunities.*
Learn to Shred/Shred More Waiver

Please read all the information below - you will be sent a version of the waiver below that you will be required to sign upon acceptance into the program.
Dear parent or legal guardian, Elevation Outdoors is running our Learn to Shred program over the winter months for youth in the Kelowna area. The program involves teaching young people to snowboard starting from the elementary level. It also involves reflecting upon this experience and using it as a metaphor for life experiences and learning. Each program runs for four weeks, with two snow sessions each week on Wednesday or Thursday afternoon/evenings and Sunday full days. This letter is informing you of the inherent risks in the activity of snowboarding. Injury to participants is always a possibility when taking part in this sport. When learning to snowboard participants tend to fall frequently, putting their wrists, arms and tailbones especially, but other body parts as well, at risk of injury. Other risks involved with the activity include other individuals on the mountain who are not involved in the program. It is a possibility that a participant could be injured from other skiers or snowboarders who are reckless or out of control, thus impacting someone in their path. While unlikely, there is a potential for life threatening injuries or death related to snowboarding. Elevation is requesting that you fill out the form below stating that you have read and are aware of the inherent risks of this activity, before your child is permitted to participate in the program. Please be assured that all appropriate safety measures and risk management practices will be exercised while the programs are being delivered. Participants will be supervised at all times when on the mountain, and elementary terrain park use will not be permitted unless all the relevant skills are demonstrated by each participant beforehand. It is our intention to create a long-lasting, learning experience for the young people involved and we will be taking their safety very seriously.*
I have read the above statement and understand the inherent risks in the activity of snowboarding, we well as the risks of participating in the program.
Parent/Guardians Full Name*

First NameLast Name
Please Read and Sign - Parent/Guardians Signature*

Clear
I have read the above letter and understand the inherent risks in the activity of snowboarding, as well as the risks of participating in the program. I give my child permission to participate with this in mind.
Please Read and Sign - Participant's Signature*

Clear
I have read the above letter and understand the inherent risks in the activity of snowboarding, as well as the risks of participating in the program. I still want to participate with this in mind.
PHOTO AND VIDEO RELEASE - Parent/Guardian Signature

Clear
Elevation Outdoors has permission to use my or my child’s photograph/video/audio recordings to promote the organization. I understand that the images may be used in various formats not limited to print publications, online publications, presentations, websites,and social media.
CONTACTING YOUTH: Elevation Outdoors has permission to contact my child by phone (text or call) to confirm program attendance and to communicate with as need arises, during or between program dates. If you do not want this - leave this section blank.

Area CodePhone Number
Input Todays Date*

MonthDayYear
Date
Participants Medical Form

Please fill out all the requested information
Participants Name*

First NameLast Name
Participants Date of Birth*

MonthDayYear
Date
Participants BC Care Card Number*
Please provide the correct care card number
Parent/Guardians Name*

First NameLast Name
Parent/Guardians Phone number - Provide preferred contact number*

Area CodePhone Number
Parent/Guardians Alternate Phone number - provide a second number to be reached at (Work, Home, Cell)

Area CodePhone Number
Emergency Contact - Provide who we should call in case we cannot reach you in case of emergencies.*

First NameLast Name
Emergency Contact Phone Number - Please provide the number of the person listed above.*

Area CodePhone Number
Medical History
Has you child ever suffered from Asthma?*
If Yes, please provide if they have medication and what it is/usage.
Does your child suffer from any allergies?*
If yes please list what they are and any medications they take, if it is anaphylactic and if they have an EpiPen.
Does your child suffer from any of the following?*
Please select any/all that apply. Hold Cntrl or Command to select multiple entries.
Does your child suffer from any of the following?*

NonePhobiasEpilepsyDiabetesBleeding DisordersHeart ConditionsMigranes/HeadachesSeeing DisordersHearing DisordersKnee/Ankle/Joint ProblemsConcussions (current or historic)
If you selected any of the above options, please provide more information about them below.
Please let us know what the issue is/was, any medications they are on, and best practices for managing it.
When was the participants last Tetanus shot?*
Answer as accurately as possible. If not within the last 10 years, participant may receive a tetanus injection by a medical officer if they receive a tetanus prone wound.
Is your child on any ongoing medications?*
Please provide details of medications, dosage, and frequency taken.
If you answered yes to the above question, do you give permission to your child to self administer these medications?
If no please explain.
Please select any of the following non-prescription medications you give permission for your child to receive if needed.*
Hold Cntrl or Command to select multiple options.
Please select any of the following non-prescription medications you give permission for your child to receive if needed.*

Advil/Tylenol - pain/feverCold/Flu TabletsAntihistamine - bites/stings/allergiesNone
Does your child have any dietary restrictions (ie. vegan, vegetarian, gluten-free, dairy-free, allergies, etc.)?*
Please indicate "N/A" or "NONE" if none
Is there anything about your child's situation that we need to be aware of in regards to their participation in this program? Is there anything that may impact others in the program we need to be aware of? *
Example - Behavioural, Dietary, or Medical concerns
In the case of accident or illness, I authorize the caregiver to administer first aid and/or be taken to the nearest emergency centre. I consent for my child to receive medical treatment. I consent that in the event of severe injury or illness the means of transportation may be ambulance at a cost to myself.*
Parent/Guardian Signature*

Clear
I declare that the information which I have provided on this form is complete and correct and that I will notify the program if any changes occur. I authorize the facilitator who is with my child to consent, where it is impractical to communicate with me, for my child to receive such medical or surgical treatment as may be deemed necessary.
Date of Submission*

MonthDayYear
Date
This program is brought to you, in part, by:
Should be Empty:

Learn to Shred/Shred More Application Package

Learn to Shred/Shred More Waiver

Participants Medical Form

Medical History