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"Promoting Healthy, Active Lifestyles in Mi'kmaw Communities across Nova Scotia 
through the tools of Sports & Recreation..."


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_________________________________________________________________________________________________________

                                          
                                                        



HIGH FIVE TRAINING
registration
FORMS

 
HIGH FIVE TRAINING PROGRAM

Principles of Healthy Child Development

&

Quest Training

 

Mainland Regional Training
October 27 & 28th, 2004

Holiday Inn Select (Halifax Centre) – Halifax, Nova Scotia
1980 Robie Street Halifax, NS - B3H 3G5
www.hiselect.com/halifax-centre

Mainland Regional Training Deadline:  Friday, October 22nd, 2004

Cape Breton Regional Training
November 2nd & 3rd, 2004

Delta Sydney Hotel – Sydney, Nova Scotia
300 Esplanade, Sydney, NS - B1P 1A7

Cape Breton Regional Training Deadline:  Friday, October 29th, 2004


Please follow these steps:

Step 1:        Complete the enclosed package of forms. You should find the following:

§        Participant Form

§        Emergency Contact Form

§         Code of Conduct

Step 2:        Fax all completed forms (Pages 3-6) to the Nova Scotia Mi’kmaw Youth, Recreation & Active Circle for Living (MYRACL) by the attached registration deadlines:

Fax to:

Robert Bernard, Executive Director (MYRACL)
Attention:  MYRACL High Five Training
Fax: (902) 756-2984

All participants are asked to please review the following information and complete pages 3-6 and send them to the fax # (above).  Please understand that this training session is being offered as part of the overall yearly work plan of MYRACL and as such carries with it certain responsibilities as an organization that represents the YOUTH of our Mi’kmaw communities.

With this carries certain expectations during your time as trainees and as you read through the following information, it will be your responsibility to follow through with the guidelines as set forth for your safe and quality participation at this training being offered.

We sincerely hope that you will enjoy your training and use it to improve the quality of your work and programming back in your community upon your return.

Thank you for your co-operation!


Sincerely,
Robert Bernard
Executive Director
N.S. Mi’kmaw Youth, Recreation & Active Circle for Living (MYRACL)

 

Participant INFORMATION FORM

 

 

 

Name:         ________________________________________________________________

 

Address:    ________________________________________________________________

                     ________________________________________________________________
                     
Community                            Province                                    Postal Code                       

                     Telephone: (day)___________________        (night)________________________

                      Fax: _____________________       Email: _______________________________

 

Approximate distance from community to training location:  ____________________________

Do you require overnight accommodation?  Yes _____  No  _____   


Please indicate which nights you will require a hotel room: (Individuals travelling further than 200 km’s (daily return) will be covered for overnight expenses at the hotel).

1st Night _____   2nd Night ______   Both Nights ________


PS:  You will be given another participant to room in with during the training, would you prefer a certain individual?  Please indicate the name of the person:  ___________________________

(Please note:  If you require a room by yourself, this will be at your own expense).

BACKGROUND EXPERIENCE:

Are you involved in any level of coaching (if applicable):    Yes ______  or  No ______

Level: _____  Sport: _______________  NCCP Passport #:  ______________ (if applicable)

What age group(s) (male or female) are you currently involved with and in what capacity? (Please describe in some details below):

_______________________________________________________________________________

_______________________________________________________________________________

Would you be interested in being part of some future MYRACL initiatives that may involve training or coaching at the community, regional, national or International level (example:  Community teams, Regional Championships, Provincial Championships, Atlantic Aboriginal Summer Games or North American Indigenous Games (NAIG)?   Yes ____  No _____  

In what Capacity:  ____________________  

What is your current position in the community?   ____________________________________

Do you have an Indian Status, Inuit or Metis card?    YES  /  NO
If yes, what type of card is it?  ___________________    Number: _______________________

Please include a person reference for security reasons:  ______________________________
Position in community:  ________________________   Contact #:  _____________________

 

 

emergency Contact FORM

PARTICIPANTS NAME: ____________________________________________________________

Provincial Health Care #  _______________________    Province: ___________________________

Do you have any serious medical conditions, allergies or other important health information that we should know about?

_______________________________________________________________________________

_______________________________________________________________________________

In the event of an emergency, PLEASE contact the following person:

NAME:            ____________________________________________________________________

RELATION TO Participant: _______________________________________________________

TELEPHONE NUMBERS:        (Home)  _________________________________________________

                                                      (Work)   _________________________________________________

IF THE ABOVE PERSON CANNOT BE REACHED, PLEASE PROVIDE A SECOND NAME FOR US TO TRY:

NAME:   _________________________________________________________________________

RELATION TO Participant: ________________________________________________________

TELEPHONE NUMBERS:         (Home) _________________________________________________

       (Work)  _________________________________________________


CODE OF CONDUCT

Respect

  1. All participants are asked to please respect each other during all events.

  2. All participants must respect the cultural diversity of the group.  MYRACL prohibits any discriminatory practices during any training sessions or activities that it hosts.
     

Behavior

  1. Participants will refrain from comments or behaviors, which are disrespectful, offensive, abusive, racist, or sexist.
  2. All participants are asked to please attend all components of the training course, any components missed by participants will be marked as a non-completion and a report will be sent back to your community and/or organization stating the reasons why this has taken place.
  3. All participants are asked to respect the direction given from the elders and staff.

 

General

 

6.   The following are strictly prohibited and will be enforced with zero tolerance:

§         No Smoking or Chewing Tobacco or other related activities (except for the traditional use of tobacco during Opening & Closing Ceremonies).

§         No consumption of alcohol will be tolerated at any point during the training course.

§         No use of drugs (except for medication prescribed by a physician) will be tolerated at any point during the training course.

Actions taken by any participant that are in violation of the “Participant Code of Conduct” will swiftly be dealt with by myracl.  The STAFF will review all violations and take action to address the situation immediately. 

Disciplinary steps may include the following:

§        Sending an individual home at his/her own expense, or at the expense of your community or organization.

§        Reviewing an individuals’ future participation/involvement with MYRACL and all of its program activities and initiatives.

 

By signing this form participants acknowledge that they have read and understand the Code of Conduct for the MYRACL High Five Training Course and accept the consequences/repercussions, should they violate any of the provisions within the Code of Conduct. Further, I understand that MYRACL has the exclusive right to use my image/picture or name (whether in still photo, television or any other form) in association with the MYRACL programs or website and other official promotions.

 

Participant’s Name: _____________________________________

 

Participant’s Signature: __________________________________         Date: ________________

 

 

 

 

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Copyright © 2000 Nova Scotia Mi'kmaw Youth, Recreation & Active Circle for Living (MYRACL LTD.)
Last modified: January 19, 2006