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SUMMER DINNER CLUB

Through Youth | For Youth | By Youth

A safe place where youth can be themselves

Sign up for the 2024-2025 After School Drop-In

Complete the form and Submit.

2024-2025 Registration

Name (Attendee)

First Name

Last Name

Preferred Pronouns

Date of Birth

Food Allergies/Preferences

Medical Concerns

Health Card #

Name (Parent/Guardian)

First Name

Last Name

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email

Name (Parent/Guardian)

First Name

Last Name

Phone

(###)

###

####

Email

Name (Emergency Contact)

First Name

Last Name

Phone

(###)

###

####

Drop-In Rules

The youth are allowed to leave the premises at all times. The WAY encourages youth to let staff know if they leave the premises and return.

I understand

Liability Clause

I agree that the WAY will not be responsible for any injuries my youth may sustain from/while participating in any WAY activities/programs/fundraisers.

I understand

Medical Waiver

I waive my legal right against the WAY staff/volunteers for any loss, injury or damage suffered at any WAY activities/programs. I hereby authorize staff/volunteers of the WAY to have my youth transported to the hospital for any emergency treatment that may appear necessary in the event that I cannot be contacted immediately. I further consent to pay any medical expenses incurred that are not covered by my health insurance plan.

I understand

Public WiFi

I understand that my youth has access to public Wifi. While there are parental filters on the Wifi, it is my responsibility to ensure that my youth has social networking and online safety skills/awareness.

I understand

Disclosure

I understand that the WAY staff/volunteers have a duty to report any serious mental or physical health concerns to the appropriate services and/or authorities. This includes any concerns that a youth presents a danger to themselves or others.

I understand

Media Permission

I give my permission for the WAY to use my y outh’s image in the Media/Brochures/Social Networking sites to promote the WAY activities/programs/fundraisers.

YES

NO

TRANSPORTATION TO AND FROM THE WAY

The WAY reviews safety procedures with the youth, particularly as they relate to walking from Wakefield Elementary School, but is not responsible for supervising travel to and from the WAY. I understand I am responsible for transportation of my youth to and from the WAY. I understand that in signing this form, I have given consent to my youth to travel independently from school (or elsewhere) to attend the WAY. In giving this consent, I am aware, and understand, that my youth will be unsupervised and in their own care from the time they leave school (or elsewhere) until the time they arrive at the WAY. In order to ensure my youth’s safety and maintain the privilege of walking, I confirm that I have clearly discussed with my youth:  - Basic rules of staying safe on the road, including use of sidewalks and crosswalks;  - The Highway Safety Code specifies that when there is a sidewalk, pedestrians are required to use it and that pedestrians who need to cross the public roadway must use crosswalks identified for this purpose;  - Respectful behaviour toward other pedestrians and motorists; and  - Municipal by - laws state that it is forbidden to hinder or interfere with traffic. In the event a projectile causes a collision or damage to a vehicle, then it would be a criminal infraction. Questions or concerns can be directed to Matt Dowdell at director@wakefieldyouth.ca

Our Values

Youth Leadership

We believe youth should be given opportunities to develop leadership capacity.

We will be inclusive, non-judgmental, and give all of our youth a safe, welcoming environment and a role in decision-making. Everyone has a voice in the WAY.

Equal Opportunity

We will provide youth with the opportunity to try, fail, succeed, learn and grow by providing unfailing encouragement, guidance, mentoring and support. If you believe, you can achieve.

Learning

We will stay current, interesting, engaging, challenging, and cutting edge in our programs and activities by saying yes to ideas and dreams, and working hard to make them work.

Innovation

We will work in partnership and collaboration with our community, other local organizations, sponsors, and individuals to help build a healthy community. Through that engagement, our participants will learn the value of giving back to their community.