Youth Anti-Discrimination Training

Kitsilano Neighbourhood House has partnered with the City of Vancouver to host CitizenU, a powerful program on anti-racism, anti-discrimination, and community building. The program is for youth ages 15-20, is FREE and includes food and bus tickets. PHASE 1: Training Workshop PHASE 2: City-Wide Events PHASE 3: Action Team Projects April 29 June & July August-October

Throughout the project you will get to meet diverse youth from across the city who also want to reduce discrimination and promote community building. Kitsilano Neighbourhood House and CitizenU will support your events and projects to help build bridges between communities. You will gain leadership skills that you can apply to your everyday life and learn by action, not by sitting and talking! You will also leave the program with a large network of peers and adult allies that you can work with over the coming years. School credits are available for participation and youll receive a certificate.

Want to Register or Find Out More?

Contact Zsuzsi Fodor at Kitsilano Neighbourhood House zsuzsi@kitshouse.org 604-736-3588 ext. 31 3686 West 4th Avenue (2nd Floor) Tuesdays & Thursdays
CitizenU Online CitizenU Video Kitsilano Neighbourhood House Online

REGISTRATION DEADLINE: April 20 Submit Forms by E-Mail*, Mail or In Person

*scanned copy with signatures

CitizenU Registration Form

Youth Information: First Name: Home Phone #: Address: School: Emergency Contact Information: Emergency Contact Name: Work Phone #: Cell Phone #: Medical Information: Medical Number: Doctors Name: What allergies do you have? Doctors Phone #: Are you taking any medications? Name of medication: Relationship: Home Phone #: Age & Grade: Last Name: Email:

I, (parent of guardian name), give permission for my son/daughter, , (youths name) to attend Kits House Youth Programs. I understand that transportation on out trips will be by: walking, private van, and by public bus / sky train. I/we agree that my son / daughter will follow all reasonable instructions and directions of the leaders and instructors duly appointed by Association of Neighbourhood Houses (ANH) in connection with the operation of the Kitsilano Neighbourhood House program as described in the program brochure. I / we herby release, remise and forever discharge Kitsilano Neighbourhood House and ANH, its agents or volunteers, of and from all manner of actions, cause of action, claims and demand of whatever nature which results from any injury, loss or expense sustained, arising out of or in any way connected with participation in any program or attendance at any location operated by ANH. In the event that our son / daughter are injured, ill or in need of medical attention and I am unable to be contact, I authorize ANH staff to seek medical attention on my behalf.

(Parent Signature)

(Date)

Privacy: Kitsilano Neighbourhood House and the Association of Neighbourhood Houses respect your familys personal privacy. The information collected on this form is in complication with the BC Personal Information Act and is used to process the program registration, help care for the safety and well being of program participants, to provide your family on future events and programs at KNH and to gather information on our progams and program use. This general information will be provided to our funders. If you have any questions or would like a copy of the ANH Privacy Act Policy, please contact Zsuzsi Fodor zsuzsi@kitshouse.org.

CitizenU: PHOTO PERMISSION RELEASE FORM

Dear Youth/Parent/Guardians, During the course of the CitizenU Project participants may be photographed for the purpose of maintaining memories for Kitsilano Neighbourhood House (ex. newsletter, website or slideshow). Therefore Kitsilano Neighbourhood House would like to ask permission to use photos for promotional purposes. If this is acceptable please sign this release form and return it to the program facilitators. However, if you would prefer that we do not use any photos for promotional purposes then please indicate it on the form below. Thank you for your time & support!

Kitsilano Neighbourhood House CitizenU Photo Release Form I hereby acknowledge in the course of the CitizenU Program I/my son/daughter may be photographed for the purpose of maintaining memories and documenting the program process.
I give permission for Kitsilano Neighbourhood House to take or use photos I DO NOT give permission for Kitsilano Neighbourhood House to take or use photos

_____________________________________ Date ______________________________________________________________________ Parent Guardian Name (if youth under 18) Signature