GIKINOO'MADITAA

GIKINOO'MADITAA

YOUTH LEADERSHIP CONFERENCE APPLICATION
FOR: YOUTHS AGED 12 - 17

DATE: MARCH 11 - 13

WHERE: YOUTH & FAMILY WELLNESS CAMP

ACCOMMODATION AND MEALS PROVIDED ON-SITE AND TRANSPORTATION PROVIDED TO AND FROM THE YOUTH AND FAMILY WELLNESS CAMP.

Gikinoo'maaditaa is a FREE, 2-day conference which invites youth to explore leadership, identity, and personal growth in a supportive, community-centred space. This conference brings together Sacred Teachings, Land-Based-Learning, reflection, creativity, and connection to re-imagine what leadership can look like. Leadership is understood as a shared responsibility: to care for ourselves, the land, and our communities.

WHAT TO EXPECT:
- Land-Based Activities
- Cultural Teachings and Reflections
- Creative Activties
- Community Connection and Peer Learning
- Space to grow confidence, voice, and leaderhsip skills.
This gathering is for youth who want to learn, reflect, connect, and step into leadership in their communities in their own way.

YOUTH & FAMILY WELLNESS CAMP

To ensure we deliver quality services, we collect limited client information-such as services used, date of birth, and, when applicable, proof of First Nations status-to understand community needs and the types of services being accessed. All information is stored securely, accessed only by authorized staff, and may be shared in confidential, aggregated manner when required for reporting obligations.
To ensure we deliver quality services, we collect limited client information-such as services used, date of birth, and, when applicable, proof of First Nations status-to understand community needs and the types of services being accessed. All information is stored securely, accessed only by authorized staff, and may be shared in confidential, aggregated manner when required for reporting obligations.
Participants Name

First NameLast Name
Age*
Participant's Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Cabin Preference
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
First Nations StatusMetisInuitNon-StatusParent/Guardian is First Nations StatusParticipant lives on a ReserveNot ApplicableOther
Status Card Number:
Which of the following communities does the participant reside at/with?
SPECIAL MEDICAL CONCERNS (list any allergies, medications, injury, conditions or medical issues we should know about):

Emergency Contact

First NameLast Name
Phone Number for Emergency Contact
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Photo & Video Consent

Youth & Family Wellness Camp Waiver 2025: I allow for Ogimaawabiitong – Kenora Chiefs Advisory, Makate Waagamichiwanang Gakinaa’amaatiwin - Youth & Family Wellness Camp, and the Ma’mo’weh Wii’soo’ka’tiwin foundation to use the images, videos, and data collection.
Yes, - I understand the Youth & Family Wellness Camp has zero tolerance for violence, drugs, or alcohol on site.
Signature

Clear
Date

MonthDayYear
Date
Photo & Video Consent: I undersigned, do hereby grant permission to Ogimaawabiitong – Kenora Chiefs Advisory, Makate Waagamichiwanang Gakinaa’amaatiwin - Youth & Family Wellness Camp and the Ma’mo’weh Wii’soo’ka’tiwin foundation. Such use includes the display, distribution, publication, transmission, or otherwise use of photographs, images, and/or video taken of myself (or my child if they are under 18) for use in materials that include, but may not be limited to, printed materials such as: brochures, newsletters, videos, advertisement (including billboard, digital and print) and digital images for our organization. I acknowledge these images have a potential to be advertised or promoted to organizations/partners outside of the region as well. I understand I have the right to inspect or approve the video or developed material. I understand that the Videos taken become the property of the organizations. I have read and understand the contents of this consent form.
Signature

Clear
Date

MonthDayYear
Date
Upon registration of my child at Youth & Family Wellness Camp, I permit my child to participate in a full range of activities.To receive onsite first aid, from a nurse or paramedic, or first aid responder which may be required.I authorize Youth & Family Wellness Camp staff and their appointee in the event of an accident or illness affecting the above-named participant; to authorize on my behalf all procedure, including admission to hospital and necessary treatment they’re in, as he/she/they may deem essential for the care and well-being of the participant. Such action shall be taken only when immediate contact with the undersigned cannot be made.I give permission for my child to walk home from the designated drop off location upon return home from camp
Signature

Clear
Date

MonthDayYear
Date

Leadership Questions
Why are you (or the participant) interested in joining the Youth Leadership Conference?
Miigwetch for your time in completing this application.

Successful applicants will be contacted via the phone number provided in this form on March 4th.
Should be Empty:

GIKINOO'MADITAA

YOUTH & FAMILY WELLNESS CAMP

Photo & Video Consent

Leadership Questions