Fillable Youth Legal Information Form - Canada (Page 3 of 3) in pdf

CISV Canada Youth Legal Information Form -- Appointment of Temporary Guardian for Travel and Overnight Programmes

(YLIF-CAN)

Part 6: Permission to Use of Images, Video, or Written Work

I agree that CISV may use and publish photographs, video, or written work created as part of participation in the CISV

Programme for use in the production of educational or promotional materials including web pages and Facebook pages.

These items may be used and published with the participant’s first name (or nickname), age and nationality. Unless

additional parental consent is obtained, participants will not be identified by full name. NOTE: Although CISV has a Social

Media Policy, CISV cannot control uploads by participants to sites such as YouTube, Facebook, & Twitter.

Part 7: Permission to Swim

I give my child permission to participate in swimming and other water activities. My child’s swimming ability:

Swimming Ability

None

Basic

Good

(check one)

Part 8: Signatures

As proof of:

•

permitting my child to travel with the designated Adult as noted in Part 1-A above, or, alone as in Part 1-B;

•

appointing the Adult Leader and/or others as Temporary Guardian as noted in Part 2 above;

•

accepting my obligations and the release and conditions/terms noted in Part 3 above;

•

all other permissions noted in Parts 4 through 7 above

I have signed this legal document on the date stated immediately below.

Signature of

Parent or

Legal Guardian

Day / Month / Year

Part 9: National Junior Branch Code of Conduct for all PARTICIPANTS:

I, _______________________________ have read and understand each of the following statements (please check):

 I have read, understand, and agree to respect and abide by CISV International’s Info File R-7 (Behaviour and Cultural

Sensitivity) standards, guidelines, and recommendations.

 I understand that drugs (including non-prescription drugs and alcohol), weapons, violent or crude behaviour or language,

and sexual activity are STRICTLY prohibited at CISV activities.

 Only people who are assigned to my room/cabin/house will sleep there. In addition, I will respect and follow any additional

rules set for the given activity in relation to visitors being in my room.

 I will abide by the curfew set for nighttime activities (if applicable). This means I will be in my designated sleeping area

before the established time with no questions asked.

 I will exhibit respectful and reasonably quiet behavior in all areas of the site including bedrooms, hallways, elevators,

public areas, and meeting rooms. In addition, I will show respect towards all hotel/site employees and CISV chaperones.

 If I wish to leave the site for any reason, I understand that I must go with and/or get the permission of my chaperone. I

understand that it is important that my chaperone know where I am at all times.

 I will be on time to, attend, and fully participate in all activities throughout the entire programme.

 I will abide by any additional rules. If I break the rules I will be subject to disciplinary action, including but not limited to

having my participation limited in future activities to being sent home at my family’s expense, by the method deemed

appropriate by CISV. I also understand my family will have to pay for any damages that I cause.

Signature of

Participant

Day / Month / Year

March 2015 (NRM)

Page 3 of 3

Youth Legal Information Form - Canada Page 3

Related Articles

Related forms

Related Categories