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Warrior Kids Camp Registration

Warrior Kids Camp Contact

IF 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.ca

Please Select a Camp(Required)

Camp Information(Required)

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 Overview

Clinical Background and Referrals

HELPING 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 understand

Family 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)(Required)

Please fill out for each child attending camp

First Name

Last Name

Age

Gender(Required)

Male

Female

Warrior Kid Information (click + to add more)(Required)

Please fill out for each child attending camp

Date of Birth

Health Card Number

Food Allergies

Preferred pronoun

Parent Name Primary(Required)

First Last

Parent Name Secondary(Required)

First Last

Parent Relationship Status(Required)

Married

Seperated

Common Law

Other

Uniformed Service Affiliation(Required)

Parent Name with Operational Stress Injury (If different)

First Last

Email(Required)

Enter Email Confirm Email

Phone

Address of Family(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact

Please 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.(Required)

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)(Required)

Child's Name Health Card Number

Allergies/Special Health or Behaviour Considerations

Do any of your children attending have food allergies(Required)

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

Please list the names of the child and their food allergies(Required)

Do any of your children attending require an EPI Pen?(Required)

Yes

Name of Child requiring EPI Pen (click + to add more)(Required)

Please fill out for each child attending camp

First Name

Last Name

Do any of your children Medication while at camp?(Required)

Yes

Name of Child & Meiccal Directions (Name, when taken)(Required)

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 Name

Medication name and directions

Does your child have any behavioural considerations for us to support them during this camp ?(Required)

high anxiety, extremely shy, autism, learning disabilities etc.)

Yes

Name of Child & Behavioural Considerations Description (Please be specific)(Required)

First Name

Behavioural Considerations Description

About Warrior Kids Camp Program Registration Information, Consent & Limits of Confidentiality

Warrior 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 Program

PLEASE 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 liability

Limits of Confidentiality

1. 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 Consent

Photography Consent

I 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?(Required)

Warrior Kids Camp Registration

Warrior Kids Camp Contact

Family and Participant Info

Emergency Contact

Allergies/Special Health or Behaviour Considerations

About Warrior Kids Camp Program Registration Information, Consent & Limits of Confidentiality

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