New form test page Warrior Kids Camp Registration Warrior Kids Camp ContactIF FOR ANY REASON YOU NEED TO CONTACT THE WARRIOR KIDS CAMP DIRECTORS: Helena Hawryluk PhD, RSW (she/her) Email: helena@woundedwarriors.ca Jerris Popik, MSW, RSW (she/her) Email: Jerris@woundedwarriors.caPlease Select a Camp(Nécessaire)Camp Van-Es, Edmonton AB - July 3 & 4, 2025Camp Information(Nécessaire)ABOUT THE WARRIOR KIDS CAMP This one-of-a-kind program combines the essential knowledge around the impact operational stress injuries can have on children and youth in families with a Veteran or First Responder parent. The Warrior Kids Camp is a two-day in person overnight camp delivered at various locations in Canada. Kids Groups Galaxy Defenders- ages 8-10 years old Teens Group Global Guardians - Ages 11-16 years old Camp Overview Day One • Camper Drop Off 9 :00am • Camp Begins! 9:30 am • Superhero Challenges - Mindmazing! and Understanding about Operational Stress Injuries • Lunch • Field Trip Dreamcatcher Animal Therapy Ranch • Swimming • Supper • Wide Game and Camp Fire and Outdoor Games • Movie and Bedtime Day Two • Stress Buster Challenges - Painting to Music, Yoga and Positive Affirmation Rocks • Closing Ceremony 1:00 pm Sharp- All Parents are invited to join in this closing celebration! • Camp Officially Ends 1:30 pm We will be sending out a packing list closer to your camp date! I have read the Camp OverviewClinical Background and ReferralsHELPING CHILDREN AND YOUTH UNDERSTAND THE SECONDARY EFFECTS OF OPERATIONAL STRESS An Operational Stress Injury (OSI) is a term used to describe any persistent psychological difficulty resulting from occupational duties. OSIs include diagnosed medical conditions such as anxiety, depression and post traumatic stress disorders (PTSD), as well as a range of less severe conditions. We do not require a formal diagnosis with a psychological injury however we do require a recognition within the family unit that a parent has been impacted by an OSI. Examples of this is Post Traumatic Stress or Post Traumatic Stress Disorder, Anxiety, Depression, Addictions, Sleep Related concerns. Please note the purpose of this program is to provide psycho-education around OSI's, introduce coping tools and strengthen peer connections between children also impacted by a parental OSI.This is not a clinical treatment program to provide direct mental health interventions. We can help provide referrals for supports that meet those needs after intake is completed or at any time during the program involvement. I understandFamily and Participant Info The information gathered below is so we can learn more about your child(ren) and your family to prepare for the best Warrior Kids Program experience. Once this form is completed it will be kept confidential, only shared between the Warrior Kids Program Directors (Jerris Popik and Dr Helena Hawryluk).Warrior Kid Information (click + to add more)(Nécessaire)Please fill out for each child attending campFirst NameLast NameAge Ajouter RetirerGender(Nécessaire) Male Female Warrior Kid Information (click + to add more)(Nécessaire)Please fill out for each child attending campDate of BirthHealth Card NumberFood AllergiesPreferred pronoun Ajouter RetirerParent Name Primary(Nécessaire) Prénom Nom Parent Name Secondary(Nécessaire) Prénom Nom Parent Relationship Status(Nécessaire) Married Seperated Common Law Other Uniformed Service Affiliation(Nécessaire)MilitaryVeteranFire FighterParamedicCorrectionsPoliceRetired First ResponderParent Name with Operational Stress Injury (If different) Prénom Nom Email(Nécessaire) Saisissez un e-mail Confirmez l’e-mail PhoneAddress of Family(Nécessaire) Adresse postale Adresse ligne 2 Ville État / Province / Région ZIP / Code postal Pays AfghanistanAfrique du SudAlbanieAlgérieAllemagneAndorreAngolaAnguillaAntarctiqueAntigua-et-BarbudaArabie SaouditeArgentineArménieArubaAustralieAutricheAzerbaïdjanBahamasBahreïnBangladeshBelarusBelgiqueBelizeBermudesBhoutanBolivieBonaire, Saint-Eustache et Saba Bosnie-HerzégovineBotswanaBrunei DarussalamBrésilBulgarieBurkina FasoBurundiBéninCambodgeCamerounCanadaCap-VertChiliChineChypreColombieComoresCongoCorée (République de)Corée (République populaire démocratique de)Costa RicaCroatieCubaCuraçaoCôte d’IvoireDanemarkDjiboutiDominiqueEspagneEstonieEswatiniFidjiFinlandeFranceFédération RusseGabonGambieGhanaGibraltarGrenadeGroenlandGrèceGuadeloupeGuamGuatemalaGuernseyGuinéeGuinée équatorialeGuinée-BissauGuyaneGuyaneGéorgieGéorgie du Sud et Îles Sandwich du SudHaïtiHondurasHong KongHongrieIndeIndonésieIrakIranIrlandeIslandeIsraëlItalieJamaïqueJaponJerseyJordanieKazakhstanKenyaKirghizistanKiribatiKoweïtLa BarbadeLa RéunionLesothoLettonieLibanLiberiaLibyeLiechtensteinLituanieLuxembourgMacaoMacédoine du NordMadagascarMalaisieMalawiMaldivesMaliMalteMarocMartiniqueMauritanieMayotteMexiqueMicronésieMoldavieMonacoMongolieMontserratMonténégroMozambiqueMyanmarNamibieNauruNicaraguaNigerNigériaNiuéNorvègeNouvelle-CalédonieNouvelle-ZélandeNépalOmanOugandaOuzbékistanPakistanPalauPanamaPapouasie-Nouvelle-GuinéeParaguayPays-BasPhilippinesPolognePolynésie françaisePorto RicoPortugalPérouQatarRoumanieRoyaume-UniRwandaRépublique DominicaineRépublique TchèqueRépublique arabe syrienneRépublique centrafricaineRépublique démocratique du CongoRépublique démocratique populaire du LaosSahara occidentalSaint BarthélemySaint MartinSaint Pierre et MiquelonSaint-Christophe-et-NevisSaint-MarinSaint-SiègeSaint-Vincent-et-les GrenadinesSainte-Hélène, Ascension et Tristan da CunhaSainte-LucieSalvadorSamoaSamoa américainesSao Tomé et PrincipeSerbieSeychellesSierra LeoneSingapourSint MaartenSlovaquieSlovénieSomalieSoudanSoudan du SudSri LankaSuisseSurinameSuèdeSénégalTadjikistanTanzanie (République-Unie de)TaïwanTchadTerres Australes FrançaisesTerritoire britannique de l’océan IndienThaïlandeTimor orientalTogoTokelauTongaTrinité et TobagoTunisieTurkménistanTurquieTuvaluUkraineUruguayVanuatuVenezuelaVietnamWallis et FutunaYémenZambieZimbabweÉgypteÉmirats arabes unisÉquateurÉrythréeÉtat palestinienÉtats-UnisÉthiopieÎle BouvetÎle ChristmasÎle MauriceÎle NorfolkÎle de ManÎles CaymanÎles CocosÎles CookÎles FalklandÎles FéroéÎles Heard et McDonaldÎles Mariannes du NordÎles MarshallÎles PitcairnÎles SalomonÎles Turques et CaïquesÎles Vierges américainesÎles Vierges britanniquesÎles de Svalbard et Jan MayenÎles mineures américainesÎles Åland Emergency ContactPlease ensure this information is up to date for start of the program so we can use this to get in touch with the emergency contact at any time during our Warrior Kids Camp.The name of an emergency contact we can call (outside of parents/guardians) incase we can not get a hold of parents during camp.(Nécessaire) First and Last Name Phone Number * Child's NAME and ALBERTA/BC/ONTARIO HEALTHCARE NUMBER (please list ALL children's names and Health Numbers below)(Nécessaire) Child's Name Health Card Number Allergies/Special Health or Behaviour ConsiderationsDo any of your children attending have food allergies(Nécessaire)Please indicate for each child you are registering for any food allergies for the meals provided during the camp program AND behavioural or medical issues that may help us best adapt our program delivery. Yes No Please list the names of the child and their food allergies(Nécessaire)Do any of your children attending require an EPI Pen?(Nécessaire) Yes No Name of Child requiring EPI Pen (click + to add more)(Nécessaire)Please fill out for each child attending campFirst NameLast Name Ajouter RetirerDo any of your children Medication while at camp?(Nécessaire) Yes No Name of Child & Meiccal Directions (Name, when taken)(Nécessaire)Please list any medications and instructions for medication use during camp (ie. my child is allergic to horses and will bring medication in case he/she needs it). Please be as clear as possible - which child needs the medication - how often etc.First NameMedication name and directions Ajouter RetirerDoes your child have any behavioural considerations for us to support them during this camp ?(Nécessaire)high anxiety, extremely shy, autism, learning disabilities etc.) Yes No Name of Child & Behavioural Considerations Description (Please be specific)(Nécessaire)First NameBehavioural Considerations Description Ajouter RetirerAbout Warrior Kids Camp Program Registration Information, Consent & Limits of ConfidentialityWarrior Kids Programs are clinically designed so kids can still connect to know they are not alone, develop peer relationships and develop critical resilience skills. Once an intake is completed you will be receiving further details about the camp via email. Please do not hesitate to reach out directly if you have questions. As a member of the group, it is important for each child and youth to learn how to respect the other group members’ feelings and experiences. This is done by creating group guidelines in the first session that reflects the needs of the group, the most important of which is confidentiality. Confidentiality is the promise to respect other's personal stories and information. It is important in establishing and maintaining trusting and lasting relationships, and acknowledges respect for an individual's right to privacy. Although participants will be asked to maintain confidentiality. There are a few limits of confidentiality and are outlined below: Assumption of the Risk and Waiver of Liability Wounded Warriors Canada Warrior Kids ProgramPLEASE READ CAREFULLY I VOLUNTARILY AGREE TO ASSUME ALL OF THE FOREGOING RISKS AND ACCEPT SOLE RESPONSIBILITY FOR ANY INJURY TO MY CHILD (INCLUDING, BUT NOT LIMITED TO, PERSONAL INJURY, DISABILITY, AND DEATH), ILLNESS, DAMAGE, LOSS, CLAIM, LIABILITY, OR EXPENSE, OF ANY KIND, THAT THEY MAY EXPERIENCE OR INCUR IN CONNECTION WITH THEIR ATTENDANCE AT THE WWC PROGRAM OR PARTICIPATION IN WWC ACTIVITIES (“CLAIMS”). ON MY BEHALF, I HEREBY RELEASE, COVENANT NOT TO SUE, DISCHARGE, AND HOLD HARMLESS WOUNDED WARRIORS CANADA, ITS EMPLOYEES, AGENTS, AND REPRESENTATIVES, OF AND FROM THE CLAIMS, INCLUDING ALL LIABILITIES, CLAIMS, ACTIONS, DAMAGES, COSTS OR EXPENSES OF ANY KIND ARISING OUT OF OR RELATING THERETO. I ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS “WAIVER” AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I EXPRESSLY AGREE TO INDEMNIFY AND HOLD HARMLESS WOUNDED WARRIORS CANADA AND ALL OF ITS EMPLOYEES, AGENTS AND UNDERSTAND THAT THIS RELEASE INCLUDES ANY CLAIMS BASESD ON THE ACTIONS, OMISSIONS, OR NEGLIGENCE OF WOUNDED WARRIORS CANADA. CLICK TO CONSENT - I agree that I have read carefully this waiver and fully understand that it is a release of liabilityLimits of Confidentiality1. The program facilitators have a legal obligation to report suspected child abuse (this includes physical, sexual, and emotional abuse). 2. If the program facilitators have reason to believe that a person is in danger to him/her self (suicide) or others (homicide), the staff must notify someone who has the ability to protect the person at risk. This agreement confirms that you understand the confidentiality policy for the Warrior Kids Program. This agreement needs to be signed in order for your child to participate in the group. Click to ConsentPhotography ConsentI give my consent to have my child/ren photographed during the camp program. Photographs would be used for educational, promotional and publicity purposes within reason. Parent eSignature means that you have read and understand consent of your child/ren in taking part of this program and the limits and expectations of confidentiality. By checking this, you are eSigning this form and providing consent for your child/ren to attend the Warrior Kids Camp I agree to the privacy policy.How did you hear about this program?(Nécessaire)Social MediaGoogleWord of MouthPast ParticipantOther