Registration forms - programs and services - children and families - girls group

To speak directly with an employee, call the Early Years Centre at 250-768-4838 (8:30am to 4:30pm, Monday through Friday).

*The girls group is now full. We are still accepting registrations, but new registrations will be put on a wait list to join the September intake.

* Name of participant (first and last)

* Birth date (mm/dd/yyyy)

Open the calendar popup.

* Age

Restrictions on activities

Allergies or special diet

Medications

Health card #

Doctor's name

Doctor's phone number

Select all that apply to participant WFN Member
Aboriginal
Community member/resident

Parent(s) or primary care-giver information

Note: Communication about group events will primarily be done by email. Please list emails that you check on a regular basis.

Parent or primary care-giver #1

* Name

* Phone number

* Email

Parent or primary care-giver #2

Name

Phone number

Emergency contact information

Emergency contact #1

* Name

* Relationship

* Phone number

Emergency contact #2

Name

Relationship

Phone number

Releases

Westbank First Nation has a website and social media accounts where photos and videos from xixuʔtem (Girls Group) are periodically published.

* Photo release Yes, you can use pictures and videos of my child. I hereby grant Xixuʔtem (Girls Group) the permission to use my child’s likeness in photographs, video, and other media in any and all of its publications, including bulletin boards and website entries. I waive any right to royalties or other compensation arising or related to the use of the photographs or videos.
No, please do not print or publish photos or videos of my child online or in Xixuʔtem (Girls Group)-related publications.

* General release

By checking the above box, I am indicating that my daughter, named within this form, has my permission to participate in Xixuʔtem (Girls Group) and to participate in activities arranged by the leaders in this regard.

Date and time of the group is: Fridays from 3:00 to 5:00pm.

I understand that Xixuʔtem discusses topics relevant to girls’ development such as body changes, body image, media and girls and introduces them to skills such as relaxation skills, communication skills, healthy anger, journal writing, and creative visualization. I understand that the girls are encouraged to share and express themselves regarding topics.

I understand that the following group guidelines are important:

Confidentiality: what is said in the circle stays in the circle. Unless harm to self or others is revealed.
Listening: it is expected that girls listen to each other without interrupting.
Self-Paced: girls can choose to pass regarding discussion topics.

Respect: non-judgmental attitude and basic respect for others and a tech-free zone.

I/We hereby release from any liability of Westbank First Nation and all of its personnel, employees, adult leaders and representatives from any claims for unintended or unexpected accidents which might occur during participation in Xixuʔtem (Girls Group) events or traveling to or from said events. In granting this permission and release, I/We specifically recognize that my child may from time to time participate in off-site and/or outdoor activities, walks, or be transported to events by private vehicles operated by advisors or volunteers not as agents, employees or representatives. In such regard, I/We specifically release and will hold harmless Westbank First Nation, their employees, agents and representatives from any and all liability which may arise as a result of such transportation.

I understand that I may contact the facilitator with questions or comments about the group.

* Initials

Facilitator contact information:
Kim Teichroeb
T 250-768-4838 ext. 4205
C 250-575-2386
E kteichroeb@wfn.ca

Registration

Registration - programs services - children and families - girls group

Parent(s) or primary care-giver information

Emergency contact information

Releases