The purpose of the Youth Programs Information Form is to provide contact and emergency information for your child while participating in the Shilo MFRC Youth Programs.

For any questions/concerns regarding this program, please contact:
Shannon Chapman, Youth Programs Coordinator
shannon.chapman@forces.gc.ca
204-765-3000 ext. 4558

Question Title

1. Youth's Information:

Question Title

2. Parent's Information:

Question Title

3. Emergency Contact: (someone other than those listed above, in case they can't be reached)

Question Title

4. Does your child have any allergies or specific medical or behavioural conditions the MFRC Staff should be aware of?

Question Title

5. Do you grant permission to the Shilo MFRC youth programs, to take your child on local outings, such as walks in the wooded area surrounding the base, walks to bunker hill, Canex, GSH outdoor facilities, and the residential areas.

Question Title

6. Do you grant permission to the Shilo MFRC, its agents, and employees, the right to photograph you and/or your minor child registered for this program for use in any MFRC publication including print, web sites or other electronic form of social media.

Question Title

7. If your child is in grades Kindergarten-6, please indicate how your child will be getting home at the end of the program.

**Youth in grades 7-12 will be allowed to come and go from the centre at their own discretion. Children in Grades K-6 will be required to stay for the duration of the program unless other advised by the parent. 

Question Title

8. Acknowledgment  and Consent:
1. I acknowledge that it is my responsibility to advise the Youth Programs staff member of any medical or behavioural concerns of my child that may affect his/her participation in Youth Centre activities.
2. I understand that the Shilo MFRC is responsible for my child only during the time he/she is inside the Youth Centre.
3. I acknowledge that the staff of the Shilo MFRC will secure medical advice/services and will report any concerns as deemed necessary for the health and safety of anyone participating in Shilo MFRC programs. The Shilo MFRC does not assume financial responsibility for any cost associated with seeking medical advice.
4. I acknowledge that my child is accountable to Youth Centre Rules. If my child does not abide by the rules, they may be subject to the Youth Centre behaviour management policy.
5. I acknowledge that it is my responsibility to update the Shilo MFRC Youth Programs Coordinator, of any changes to vital information.

Question Title

9. FOR OFFICE USE ONLY - DO NOT COMPLETE

T