Virtual Kids Camps Registration Form | Wounded Warriors Canada

Warrior Kids Virtual Camp Signup

Warrior Kids Program 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 Virtual Camp(Required)

Parent Information

Parent Name(Required)

First Last

Uniformed Service Affiliation(Required)

Email(Required)

Enter Email Confirm Email

Phone

Name of Trauma Exposed Parent? (If different)

First Last

Address of Family(Required)

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

Participant Information

Child Information (click + to add more)(Required)

First Name

Last Name

Age

Date of Birth

Food Allergies

How did you hear about this program?(Required)

Parent Information - Consent and Confidentiality(Required)

Once your registration is completed an email will go out to you approximately 4 weeks prior to the start of the program to book an intake phone call appointment with one or both parents. This telephone intake appointment will ensure everyone is ready to begin this Warrior Kids Program journey!

The Virtual Warrior Kids Program is offered via the Zoom Conferencing Program and is a 6 week resilience promoting psycho-educational program designed to help kids who have a parent with an operational stress injury (military, Veteran, First Responders) build positive relationships with peers, gain knowledge of the injury, and new coping skills that will help them continue to thrive within their family and community.

I have read and agree to the above terms

Parent Information - Date and Times(Required)

Please review the dates and times (time zones) that your child/youth is registered in, the program runs for 6 weeks 1 hour a week and it is important for the program goals and group dynamics that your child attend each session.

I have read and agree to the above terms

Confidentiality(Required)

Although participants will be asked to maintain confidentiality in the group, they are free to discuss their own thoughts and feelings with whomever they choose after the group as long as no identifying information is shared. This means nothing about names, family members, address, etc. is shared.
Despite this atmosphere of confidentiality, there are a few limits to confidentiality as outlined below:
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.

I have read the above and by checking this box have confirmed that I understand the confidentiality policy

Parent Requirements for Setting up your Child for Success!(Required)

• Before the program please consider a quiet space and a private location with limited interruptions or distractions.
• Your child’s space should be away from the hustle and bustle of the household if possible.
• Please note that although using the video feature/camera is not mandatory we strongly encourage participants to have their camera on at the beginning of the session and during group discussion/interactive activities in order to support developing relationships with others in the group and build connection.

I have read and agree to provide the following to support my child/ren

Parent Requirements for Setting up your Child for Success!(Required)

I have read and agree to provide the following to support my child/ren

Parent Requirements for Setting up your Child for Success!(Required)

• We have created this program with the evidence that children need their own space outside of their parents to learn, listen and ask questions about mental health in order to best support their needs. With this in mind please support the program goals by allowing your child to maintain a comfortable space away from parents to complete this program. If you have any questions or concerns about this please contact Warrrior Kids Program Directors, Jerris Popik or Dr Helena Hawryluk or discuss this during your intake call with the directors prior to the start.

I have read and agree to provide a private and comfortable space for my child

Parent Requirements for Setting up your Child for Success!(Required)

• During the program we ask that you are in a nearby room and are accessible by phone should your child require behavior modification, technological issues occur, or in the event that your child may require additional emotional support.

I have read and agree to the above

Family Information(Required)

Has the OSI been formally recognized in the family? (Don't worry if you haven't been able to find the right way to explain this to your children. We can help with that during our intake call and first family meeting!)

Yes

Not sure

What are you hoping for your child/teen to get out of attending this program?(Required)

Do you have any concerns about your child/ren attending this program?(Required)

Parent Requirements for Setting up your Child for Success!(Required)

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 have read and understand the above information(Required)

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