Youth Legal Information Form - Canada
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Appointment of Temporary Guardian for Travel and
Overnight Programme Registration ( YLIF-CAN )
FOR CANADIAN PROGRAMMES ONLY
This form assigns temporary guardianship for travel and overnight programmes, and is for youth participants under the
age of 19 at the time of departure for the CISV programme. As this form is used for a range of activities (cookie-a-thons,
minicamps, NBM, SBTF, National Camp, etc.), some sections may not apply. This form is NOT for use for international
programmes whether held in or outside Canada.
The Adult Leader/Chaperone (if applicable) or the Participant must carry the signed original to the CISV programme. A
scanned copy is retained by the participant’s home CISV Chapter.
“CISV” includes CISV Canada and its Chapters, together with all leaders, staff, volunteers, employees, and members.
CISV Programme
Activity Starting Date & Time
(e.g. NBM, ABC Minicamp)
Host Chapter (or CISV Canada)
Activity Ending Date & Time
Leader/Chaperone’s cell
Name of Adult Leader/Chaperone
Participant Name
Preferred Name
Email Address
Date of Birth
Gender
(d/m/yy)
Are you a member of CISV? (Y/N)
Chapter
Add to chapter email list? (Y/N)
If not, have you attended other CISV activities this year?
Parent or Legal Guardian (Full Name)
Number & Street
City & Province
Postal Code
Home Telephone
Cell Number 1
Cell Number 2
Email Address/es
Emergency Contact during the activity
(other than parent/guardian):
Home Telephone
Cell Number 1
Cell Number 2
Part 1: Authorization
Youth may be traveling alone in certain circumstances: if they are of appropriate age or if they are travelling to meet their
delegation/leader, based in another Canadian city. Please check one of the following:
A)
For Participant to travel with a designated Adult
I give permission for my child to travel to and from the CISV Activity with the designated Adult named above.
B)
For Participant to travel without a designated Adult
I give permission for my child to travel alone to and from the CISV Activity/Programme.
C)
Not Applicable
Other adults authorized to pick up your child:
NOTE: Youth will ONLY be released to parent/guardian or those named above.
March 2015 (NRM)
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