Registration form for participants jeux de la francophonie canadienne 2011



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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 1st 2011, Arts and Sports except athletics – March 31st 2011, athletics – March 31st 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


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: 2nd 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

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


Code of conduct

  1. 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;

  2. Consumption or possession of illicit drugs is prohibited in all public buildings at the Canadian Francophone Games;

  3. Smoking is prohibited in all public buildings at the Canadian Francophone Games;

  4. 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;

  5. Under-aged participants are not to leave the official Canadian Francophone Games’ venues without an accompanying adult from their delegation;


Commitment – The participant:

  1. 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;

  2. Is committed to observe the Games’ curfew (11pm);

  3. 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;

  4. 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;

  5. Must complete the attached medical form properly;

  6. Must use French as his/her SOLE language of communication during the Games;

  7. 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

  1. 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;

  1. 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;

  2. 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;

  3. 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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