Registration form for participants jeux de la francophonie canadienne 2011

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It is important to know that
Conditions
Administrative Zone – To be filled by the Youth Association only

REGISTRATION FORM FOR PARTICIPANTS

Jeux de la francophonie canadienne 2011

Dear participant, please …

Insure that you fill this form with print characters and that your name and personal information are legible, as these details will be used to purchase you plane ticket, as the case may be, for your accreditation and to post your results on the Games Website.

It is important to know that:

You can register to only ONE discipline;
Deadlines to register are: Leadership – March 1^st 2011, Arts and Sports except athletics – March 31^st 2011, athletics – March 31^st 2011;

Your, as well as your coach or chaperone will be in classrooms, dorm style. Do not forget to bring in your luggage: a mat (twin size), a sleeping bag, a pillow and all your toiletries necessities including a towel;
Transportation for all participants in Sudbury, including coaches and chaperons, will be in school or city buses;
Meals for all participants, including coaches and chaperons, will be served at the cafeteria. Occasionally you could receive a take out lunch box. It is important to note that the Games Organising Committee, as well as the FJCF, will do everything in their power to control typical allergenic foods in the cafeteria. However, it will be impossible to control the presence of allergenic foods in vending machines and at food independent courts on the Games venues.

Conditions

Registration fees for ALL team members participating at the Games will be $ 250 per person + $100 for provincial or territorial expenses, which include team preparation (camps, apparel, etc.), for a total of $ 350.
Fees for extra coaches or chaperons ($ 350 per person + national transportation costs).
Reimbursement conditions: IN ALL INSTANCES, fees are not refundable.
Substitution: Substitutions will be permitted in certain occasions (conditions are included in the Delegation Guide provided to the Youth Association). No fee will be required if the specific discipline deadline has not pass. However, an administration fee of $ 25 will be required per substitution after this specific deadline (see previous paragraph, line 2).

Administrative Zone – To be filled by the Youth Association only

Completed Form Received on(date dd/mm):
Payment Type: Cach Cheque – Cheque number:
Details entered in the database on (date dd/mm):	By (name):
Photograph Uploaded Passport type photo, head and shoulders only (no full length photo); Please no hats, baseball caps that could shadow your face; Smiles are acceptable, funny faces or facial contortion not so much; Preferably on a light uniform background; Please note that the database program will reformat your pictures to fit the accreditation card, so the size doesn’t matter, as long as it is a image file (JPEG, GIF, TIFF or Bitmap).
Optional For coaches and chaperons – criminal check done on (date dd/mm):
Other information:

PERSONAL INFORMATION

First Name:

Last Name:

Role: Athlete/Artist/Leader Chaperone /Coach – NCCP Certification Number _______________________

Chef de mission Assistant chef: ( Arts Leadership Sports)

Other role (medical, photograph, etc., Please specify)

First Aid Certification

Yes No

Expiration Date (mm/yyyy) ____________________

Cardiopulmonary Resuscitation Certification (CPR)

Yes No

Expiration Date (mm/yyyy) ________________________

Sex: F M

Date of birth ___/___/______

(dd / mm / aaaa)

Unit #:

Street:

Ap:

City/Town:

Province/Territory:

Postal Code:

Home Phone:

( ) -

Mobile:

( ) -

Email:

Clothing size (in general):

XS S M L XL XXL XXXL

This is a substitution. Please indicate the name of the person you’re replacing ($ 25):

This is a registration for an extra coach or chaperon ($ 350)

Note: provide a digital photograph/portrait, head and shoulders only, to your delegation

Select a discipline/event

ARTS

Visual Arts MEDIUM ( Painting Sculpture Drawing Collage)

Please select your preferred medium; you will be able to work with all the different medium and tools available at the Games.

Improvisation Mix Tournament

Music: Solo Group

Interpretation competition of francophone songs and original compositions, for solo artist and groups. If you are a solo artist, musicians can accompany you.

Circus Arts (demonstration) Mix Competition

LEADERSHIP

Chef de mission apprentice

Media

Event management

SPORTS

Athletics (four (4) event maximum and two (2) events minimum per participants – indicate best time or distance for each event)

Women		Men			Category Cadet (1996-1997)		Juvenile (1993-1994-1995)
Races:	100 m	200 m		400 m	800 m	1200 m	2000 m		4x100 m
						1500 m	3000 m
Jumps:		high jump			long jump		triple-jump
Throws:		shot put			javelin		discus
Best result:			Date:		Best result:			Date:
Best result:			Date:		Best result:			Date:

Badminton (one (1) singles and one (1) doubles event maximum per participant)

Singles Women	Singles Men		Doubles Women	Doubles Men		Doubles Mix
Provincial/Territorial Ranking:		Date:	National Ranking:		Date:
Best result:			Date:
Best result:			Date:

Basketball 3 x 3

Women Tournament

Men Tournament

Volleyball

Women Tournament

Men Tournament

Canoe (demonstration)

Women				Men				Mix
100m C1	200m C1	500m C1	1000mC1	100m C1	200m C1	500m C1	1000m C1	Portage
100m C2	200m C2	500m C2	1000mC2	100m C2	200m C2	500m C2	1000m C2	Portage

MEDICAL FORM :

Name of parent or legal guardian to reach in case of emergency:	Day Phone:	( ) -
	Evening Phone:	( ) -
How is this person related to you:	Mobile:	( ) -
	Email:
This person will be present at the Canadian Francophone Games? Yes No

Medical insurance coverage for the Games, please choose one:

Provincial coverage	Insurance #:
Blue Cross	Insurance #:
Other (Please specify	Insurance #:

Food needs:

Food allergies – I am allergic to:

___________________________________________________________________________________________________

I can have an allergic reaction if I eat the food in question? Yes No
I can have an allergic reaction if I am in contact with the food in question (smell, touch)? Yes No
I can potentially die from my allergic reaction (anaphylactic choc)? Yes No
I have an epipen in case of emergency and my team knows about my condition? Yes No

If not, please inform the person responsible for your team of your condition as soon as possible.

Please be as specific as possible regarding your allergies, this will help us meet your food needs adequately.

Other specific food request (not related to allergies):

Vegetarian Vegan Others (Please specify) _______________________________________________________________________

Medical Specifics:

I use a wheelchair ( manual electric) or crutches to walk? Yes No

Please specify your accessibility needs:

I have:

Asthma Diabetes Migraines Heart condition: (Please specify)

Allergies, other that food related: (Please specify)

Most recent immunization for:

Tetanus – date (mm/aaaa): ________________________ Hepatitis B – date (mm/aaaa): __________________________

I must take the following medication(s) and/or follow certain recommendations (specify special instructions, frequency and any other relevant or important information pertaining to your health):

Please indicate if you have had previous injuries (example: 2^nd degree sprain left ankle in 2009):

Family Doctor :

Name of your family doctor:

Doctor’s phone number:

( ) -

Notes:

In case of extreme emergencies, in which ambulance services are required, the costs shall be assumed by the parent or guardian as provincial or territorial health plans do not cover ambulance services.
A provincial/territorial health insurance card must be provided whenever a participant is taken to hospital. Note that there could be fees. Participants will have to pay directly for all medical cost and seek reimbursement through their health care program.

Date: ____________________ Signature of Participant: _________________________________________________________________

Date: ____________________ Signature of Parent or Legal Guardian: _____________________________________________________

(The signature of a parent or guardian is required for individuals under 18 years of age)

CONSENT FORM
Selection criteria

Must be born between January 1, 1993 and December 31, 1997;

Code of conduct

Consumption or possession of alcohol will be prohibited for participants, provincial or territorial team personnel, employers or organisers for the duration of the Canadian Francophone Games; except during receptions that are not held on the Games’ venues and are organised by the Organising Committee, as long as people present are 18 years and older. At any time, it is preferable that adult team members, in charge of young participants, refrain from consuming any alcohol, even during such receptions;
Consumption or possession of illicit drugs is prohibited in all public buildings at the Canadian Francophone Games;
Smoking is prohibited in all public buildings at the Canadian Francophone Games;
A sanctioning committee will deal with harassment, abuse, vandalism or damage complaints on a case by case basis and will make a decision as to the appropriate sanctions;
Under-aged participants are not to leave the official Canadian Francophone Games’ venues without an accompanying adult from their delegation;

Commitment – The participant:

Is committed to represent his/her delegation at the Sudbury 2011 Canadian Francophone Games to the best of his/her abilities, from his/her departure for Sudbury to their return home;
Is committed to observe the Games’ curfew (11pm);
In addition to his or her provincial or territorial medical health plan and to cover for any extra fees not paid by their plan, it is recommended that the participant acquires private travel or medical insurance coverage for the duration of his/her stay;
Assumes all liability for any bodily harm or material damage that may occur, prior to, during and after the Games (JFC 2011), including personal injuries as well as the theft of, loss of or damage to his/her property. The participant agrees not to hold the Fédération de la Jeunesse canadienne-française and the Organising Committee liable for any harm to his/her person (in any capacity) nor for any loss or damage to property. In no case shall the FJCF or the Organising Committee be liable for any action resulting from any contract and tort responsibility stemming from fault or negligence;
Must complete the attached medical form properly;
Must use French as his/her SOLE language of communication during the Games;
Must only use transportation services provided by the Games: Games shuttles (bus), Games emergency “ shuttles ” (vehicles driven by volunteers), delegation transportation at the Games (vehicles rented by the delegations for occasional transportation during the Games);

Consent – Personal information

The FJCF and the Organising Committee of the Canadian Francophone Games will assume communications and marketing responsibilities for the Games. They plan to:

Collect and broadcast images of Games’ participants, on the Games’ Website and on promotional material;
Provide participants’ information to the media and public for promotional purposes;
Coordinate on-site interviews with accredited members of the media;

In registering for the Canadian Francophone Games, I consent to being photographed or videotaped for use in the Games Organising Committee or the FJCF promotional or educational purposes on the Games and the FJCF Websites, pamphlets, TV adds or any other tool used to promote the Games or the FJCF;
In registering for the Canadian Francophone Games, I consent that my personal information be published on the Games’s Website, on results sheet and boards and in documents for the public and the medias. This personal information include: my complete name, the team I belong to, my city of residence/birth and my age;
Please check the appropriate box: I would like to receive by email information about future activities organised by the Youth Association in my region and the FJCF. Please add me to your mail list. Yes No .

The participant and his/her legal guardian hereby acknowledge having read, understood and accepted the above conditions and requirements and agree to abide by them at all times.

Date: _______________ Signature of Participant: _______________________________________________________________
Date: _______________ Signature of Parent or Legal Guardian: ____________________________________________________

(The signature of a parent or guardian is required for individuals under 18 years of age)

Contact information :
The completed form must be returned before March 31st, 2011 to Natasha Harvey :
L’Association franco-yukonnaise

302, rue Strickland

Whitehorse (Yukon) Y1A 2K1

(867) 668-2663 poste 850

nharvey@afy.yk.ca

www.espoirjeunesse-yukon.ca

Participant Registration – Jeux de la francophonie canadienne 2011 /

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