Fraser Valley Aboriginal Children and Family Services Society
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Visions & Voices Forum Registration 2019

  • Registering Youth

  • MM slash DD slash YYYY
  • Yes, I, , agree to participate in all events and follow all rules and guidelines of Visions and Voices.

  • Clear Signature
    *Above section must be completed by Youth Registering.
  • Parent/Guardian Information

  • Clear Signature
  • MM slash DD slash YYYY
  • Clear Signature
  • MM slash DD slash YYYY
  • Participation Permission Form:

    consent and authorize Xyólheméylh to use and reproduce photographs taken of my child and to circulate same for advertising or publicity purposes of every description.

    2. It is our policy that we (Xyolhemeylh) notify a parent/guardian when a child is ill or needs medical attention. Occasionally, we are unable to contact parents/guardians and require immediate assistance for the child. Our procedure is to call an ambulance and transport your child to the nearest emergency center.

    3. In the event of an injury or medical emergency, it is the policy of Xyólheméylh that the decision to call an ambulance (at the parent/guardian’s expense) rests with the trained staff on duty.

    4. I hereby give consent for my child, , when ill or injured to be taken by ambulance to the nearest emergency center when I cannot be contacted.

    5. I have provided the proper medical information and medical card number for my child.

    6. I hereby give consent for Xyólheméylh Staff to administer the following medications to my child, listed below.
  • All medications must be in blister packs from the pharmacy with the original prescription label. All medications must be given to the Xyólheméylh staff upon arrival to Vision & Voices.
  • Medical Information

    (Please list medications below.)
  • Medication NameWhen It Is GivenAmount or DoseHow It Is Given 
  • Emergency Contact Information:

    Please provide two emergency contact names and phone numbers we can call if there is an emergency:
  • Clear Signature
  • MM slash DD slash YYYY
  • Please ensure your child is free from any communicable diseases or contagious diseases (examples: flu, scabies, pink eye, strep throat, head lice, etc) If your child arrives at Vision & Voices with a communicable disease they will be sent home.
  • Additional Information

    Tell us anything else you'd like us to know.
  • Code of Conduct

    This contract must be signed and dated by the participant and a parent/legal guardian. This contract is designed to help participants and parents/guardians understand the expectations of the participants. Please read carefully, sign and date this form then return to Xyólheméylh attention Vision and Voices with the completed registration form, participant permission form and waiver form.

    I, , agree to abide by the following:

    1. I will promote a positive, productive, and supportive environment for the group.
    2. I will notify Xyólheméylh employees of any injury or illness.
    3. I will refrain from using foul and demeaning language.
    4. I will not use any alcohol, cigarettes or drugs other than medication prescribed to me by a doctor. I understand that if I use alcohol, cigarettes or drugs I will be sent home as soon as possible at my own expense.
    5. I understand that it will be the decision of Xyólheméylh employees that if any term of this contract is broken I will be sent home immediately.
    6. I understand that my Parents/Guardians/Emergency Contact persons will be contacted AT ANY TIME of the day or night in the event I am returning home due to an emergency or failure to abide by the Code of Conduct.

    I, , Visions & Voices Registrant, have read and understand all of the forms provided. I acknowledge and accept full responsibility as described above.

  • Clear Signature
    Please draw your signature within the box.
  • Clear Signature
    Please draw your signature within the box.
  • MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.

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  • Home
  • Who We Are
    • Vision and Values
    • Board of Directors
    • Organizational Chart
    • Complaint Resolution
    • Donate
  • What We Do
    • Stó:lō Basket
    • Child Safety
    • Family Preservation
    • Guardianship
    • Foster Care
  • Our People
    • Caregivers
      • Caregiver Resources
    • Youth In Care
      • Youth Resources
    • Elders
  • News & Events
    • News
    • Events
  • Careers
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