CYAID 2015 Registration Forms

Transcription

CYAID 2015 Registration Forms
2015
Canadian Youth
Against Impaired Driving
National Conference
Fredericton, New Brunswick
May 21st – 23rd, 2015
TADD New Brunswick is pleased to invite you to join us for the upcoming
Canadian Youth Against Impaired Driving National Conference.
We are a group of dedicated Students and Volunteers who strive to bring the message
home to our youth year after year.
That message is “FRIENDS DON’T LET FRIENDS DRINK AND DRIVE”.
You can visit us on the web at
www.taddnb.com
Welcome to the 2015 National CYAID Conference. Registration forms are attached.
CONFERENCE
INFORMATION
CONFERENCE DATES:
May 21st – 23rd, 2015
CONFERENCE LOCATION:
Fredericton NB
REGISTRATION
 All official registration forms will be on our website and are included in this package. You must use
these forms to register.
 Please keep reading so you are aware of the requirements and arrangements.
DEADLINE FOR REGISTRATON:
April 24th, 2015
WHERE TO SEND YOUR REGISTRATION
Attention: TADD NB
383 French Village Road
Quispamsis, NB E2S 0C4
CONFERENCE CONTACT
The conference coordinator for TADD NB is Sarah Cormier - McHugh. All contact can be made via email to
[email protected] by telephone at (506)636-2324. If required to leave a message, please be sure to leave your name,
contact phone numbers, including area code and a brief message regarding your inquiry.
ADULT ADVISORS
All groups of delegates attending CYAID 2015 must attend with an adult advisor. An adult advisor is the ‘adult’, over the
age of 18, who is FULLY responsible for the delegates that are attending with their group at all times. They accept full
responsibility for their delegates; for supervision, behaviour, medical needs, etc. TADD NB does not coordinate any
supervision or accept any responsibility for delegates.
CONFERENCE ACCOMMODATIONS
All accommodations will be booked by TADD NB – CYAID 2015 organizers. Accommodations will be on the University of
New Brunswick Campus, Fredericton (UNB). Accommodations will be blocked for your delegation once we have received
payment. The rooms are dormitory rooms with 2 single beds per room, or a single at an additional fee.
PLEASE NOTE: You will need to bring your own Towels and Sundries.
REGISTRATION
Registration will be accepted from February 1st through April 24th, 2015. We shall process registrations that are received in
the mail – with full payment – on a first-come - first serve basis. We will NOT HOLD SPACE in anticipation of your
attendance. You will receive an email confirmation within 5 business days of receipt of your registration and payment. You
must use the ‘official’ registration form, which enables us to process your registration efficiently. Please be sure all required
fields are completed in full. We will not accept any registrations without payment. Late registrations will be accepted upon
individual review and space availability. If you require an extension to this deadline – please contact us at
[email protected].
ACCOMMODATION
We will book accommodations in the following occupancy categories ONLY:
1. Single Occupancy with one person in the room.
2. Double Occupancy with two people in the room and two beds (a bed each).
The rooms are dormitory rooms with 2 single beds per room.
*If you have a single delegate, that you cannot block in with other delegates from your group, please request double occupancy and we
will partner them up with one more individual delegate from another group, therefore each person having their own bed (Only if this
option is available). Keep this in mind when preparing your delegates list for the conference; it is our STRONG RECOMMENDATION
to bring delegates that can fill all of your own rooms - rather than having to have rooms completed with delegates from other schools.
CONFERENCE FEES
The following is the breakdown of pricing for CYAID 2015. The prices listed are PER PERSON. All fees are based upon
the occupancy in the rooms. All accommodations will be arranged by TADD NB. The conference fee includes all
conference costs starting on Thursday and concluding Sunday Morning - as per the agenda. This includes speakers,
activities, meals, etc. Delegates are responsible for all transportation to and from the conference site, as well as all
personal spending money. PLEASE MAKE ALL CHEQUES PAYABLE TO ‘TADD NB’
Student Delegate Rates
(Conference & Accom.)
Adult Advisor Delegate Rates
(Conference & Accom.)
Single Occupancy - $325.00
Double Occupancy - $275.00
Single Occupancy - $325.00
Double Occupancy - $275.00
THESE RATES ARE PER PERSON
THERE IS NO CONFERENCE FEE WITHOUT ACCOMMODATIONS EXCEPT FOR DELEGATES LIVING IN THE CITY OF
FREDERICTON. PLEASE CONTACT [email protected] FOR RATE DETAILS.
ADULT ACCOMMODATIONS
Adult Advisors are not placed with students unless the group specifically requests it. If you wish to be placed with your
students, please indicate so on your registration form by noting “sharing with students”.
We do not place adult advisors in with students to fill space, and we therefore request that you select your advisor
accommodations accordingly. We will accommodate advisors travelling alone with a request to place them into a double
occupancy room with another advisor of the same sex, with each having their own bed. We will work diligently to place
contingent delegates’ rooms in close proximity to their adult advisors.
CANCELLATION POLICY
If, for any reason, you cancel your registration before the April 24th, 2015 registration deadline, your delegate fees will be
reimbursed less a $50 administration fee.
There will be NO REFUND for cancellations after April 24th – as all rooms and meal counts will have been guaranteed.
To avoid delays in the processing of your application form, please be sure that everything that the
CYAID registration team requires is enclosed with your full payment.
Please use the checklist below to be sure the registration package you are sending in for CYAID 2015
includes the following paperwork. Please be sure that all delegates’ names are spelled correctly as they
will be used for all nametags, etc.
THINGS I NEED TO SEND
DONE
Completed information page and Informed Consent for every delegate that is a minor
Completed information page for every advisor
Complete rooming list - including names of all delegates and advisors
Full payment for every delegate (student and advisor) based on PER PERSON rates
All contact information for my delegates’ group
(including day and evening phone numbers)
YOUR REMINDER NOTES OR QUESTIONS FOR CYAID COMMITTEE:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
On the following pages, please fill in your Group / Delegate information on the “Group Information Page”.
The following table is a ‘sample’ of the information that is required on that page.
COMPLETE
First and Last Name
of Every Delegate
Advisor (A)
or Grade of
Delegate
Male or
Female
Room Type
(S, D,)
Room Rate Based
Upon Type
Requested
Room
Number
Smith, John
11
M
D
$275
1
Krause, Billy
11
M
D
$275
1
George, Randy
10
M
D
$275
2
John, Johnathon
10
M
D
$275
2
Jacobs, Nancy
12
F
D
$275
3
Weller, Becky
11
F
D
$275
3
Anderson, Jamie-Lynn
A
F
S
$325
4
CYAID 2015 REGISTRATION
PAGE
This page is to be submitted.
FULL NAME OF YOUR
GROUP
GROUP’S HOME
PROVINCE/TERRITORY
NAME OF ATTENDING
PRIMARY ADULT ADVISOR
PRIMARY ADVISOR CONTACT (Days)
PHONE #
(Please include area code)
(Evenings)
(
)
(
)
PRIMARY ADVISOR EMAIL
PRIMARY ADVISOR MAILING
ADDRESS
TOTAL NUMBER OF
DELEGATES ATTENDING
(INCLUDING ADULT ADVISORS)
AMOUNT OF PAYMENT
ENCLOSED
A reminder of the conference fees … per person rates
Student Delegate Rates
(Conference & Accom.)
Single Occupancy - $325.00
Double Occupancy - $275.00
Adult Advisor Delegate Rates
(Conference & Accom.)
Single Occupancy - $325.00
Double Occupancy - $275.00
GROUP
INFORMATION
This page is to be submitted
COMPLETE
First and Last Name
Of Every Delegate
Advisor (A)
Or Grade of
Delegate
Male or
Female
Room Type
(S, D, T, Q)
Room Rate
Based Upon Type
Requested
Room
Number
If you require additional space as you have a large group of delegates, please add an additional copy of
this page and submit all additional delegates on the second page.
DELEGATE
INFORMATION
(This must be completed by EACH delegate and sent
in with your registration)
LAST NAME ________________________________FIRST NAME ________________________________
Age __________
Grade __________
OR
STUDENT (
)
NOTE:
All delegates under 18 years of age must also submit an ‘Informed Consent’ with their
registration form. The Informed Consent Form appears on the next page.
ADULT (
)
Your Group’s Name (IN FULL) ____________________________________________________________
Name of Adult Advisor: _________________________________________________________________
Your Home Address: ____________________________________________________________________
City/Town __________________________ Province ________________ Postal Code: _______________
Email Address: ________________________________________________________________________
Home Telephone: (
) _________________________ Cell Phone: (
) ______________________
Emergency Contact Name: _______________________________________________________________
Emergency Telephone #: (
) ____________________________
Doctor’s Name: ____________________________ Doctor’s Telephone #: (
) ___________________
Specify any medical conditions that we should be aware of (i.e. Asthma, Epilepsy, Allergies, Etc.)
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
FOR ADULT ADVISORS: Would you like to be a presenter at any of the adult advisor sessions? ___________________
INFORMED CONSENT
FOR A MINOR TO PARTICIPATE
IN CYAID 2015
I, the undersigned, understand and acknowledge that participation of my Child, _________________________________
in the Canadian Youth Against Impaired Driving National Conference (CYAID) in Fredericton, New Brunswick from May
21st to May 23rd, 2015 (“the Event”) might result in personal injury, property damage or loss, and possible death. I also
understand that the travel associated with the Event also adds additional risk. I fully understand these risks and hereby
agree to have my Child participate in the Event voluntarily and at his or her own risk.
I warrant that my Child is physically, mentally and emotionally fit to participate in the Event.
I understand, agree and acknowledge that by choosing to have my Child participate in the Event brings with it the
assumption by me and by my Child of the risks and I assume full responsibility to instruct my Child about the risks and
the choices available to him or her relative to those risks.
I shall indemnify and save harmless the Teens Against Drinking and Driving Association of New Brunswick (2015 CYAID
Conference Hosts), all of its employees, officials, officers and authorized representatives from and against all suits,
actions, legal or administrative proceedings, claims, demands, damages, liabilities, interest, legal fees, costs and expenses
of whatsoever kind or nature in any manner directly or indirectly caused by any act of my Child in connection with or
incidental to my Child’s participation in the Event.
I, as the parent/guardian of said Child, declare that I have read, understood and agree to the contents of the Informed
Consent from in its entirety.
Dated this _____________ day of __________________________________, 2015.
Parent / Guardian Printed Name _______________________________________________________________________
Parent / Guardian Signature __________________________________________________________________________
Witness Printed Name _______________________________________________________________________________
Witness Signature ___________________________________________________________________________________
Delegate’s Group Name ______________________________________________________________________________