CRAVE Project Application Form Step 1 of 4 25% PARTICIPANT INFORMATIONIn which region of Manitoba do you live?* Winnipeg North (The Pas) West (Brandon) Other (Please specify) Other*Participant First Name* First Name Participant Last Name* Last Name Preferred name*Preferred Pronouns*Primary Phone Number*Primary Phone Type*Mobile PhoneHomeWorkSecondary Phone NumberSecondary Phone Type*Mobile PhoneHomeWorkEmail* Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code School*Community organization participant is applying through (if applicable)Grade*Date of Birth* Date Format: MM slash DD slash YYYY Gender* Male Female Other Prefer not to disclose Participant identifies as a person:* with a disability of a visible minority group of Indigenous ancestry that is a Newcomer to Canada (settled in Canada within the last five years) with Refugee status None of the above/prefer not to disclose Does Participant have a Social Insurance Number?YesNoCareer Trek can assist you with obtaining a SIN.Does Participant have a birth certificate?YesNoPreferred method of communication* Cell phone Home Phone Email PARENT/GUARDIAN INFORMATIONParent/Guardian Name* First Name Last Name Relation to Participant*MotherFatherGuardianPrimary Contact:*YesNoPrimary PhonePrimary Phone Type*MobileHomeWorkOtherSecondary PhoneSecondary Phone Type*MobileHomeWorkOtherEmail* Address (if different than Participant) Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Preferred method of communication for parent/guardian* Cell phone Home Phone Email Would you like to add an additional Parent/Guardian? Yes No Parent/Guardian Name First Name Last Name Relation to ParticipantMotherFatherGuardianPrimary Contact:YesNoPrimary Phone*Primary Phone Type*MobileHomeWorkOtherSecondary PhoneSecondary Phone Type*MobileHomeWorkOtherEmail* Preferred method of communication for this parent/guardian* Cell phone Home Phone Email Address (if different than Participant) Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Career Trek Inc. collects personal information for the purposes of communicating with parents/guardians, ensuring participant safety, and tracking program outcomes. We are committed to protecting your personal information.Career Trek publishes a monthly newsletter and issues occasional electronic information updates. Topics can include information on program changes, of special events, organizational updates, employment information, volunteer opportunities, contests, and more. You can unsubscribe at any time.Yes, keep me in the loopNo, I’m not interested ACKNOWLEDGMENT OF RISKS AND WAIVERSIn the case that any in-person programming will occur during the program, I understand that injuries can arise by accident from the very nature of Career Trek Inc.’s activities, and I hereby release and waive all rights to any claim or action against Career Trek Inc. arising from injury, loss, or damage to the participant named in this application. I acknowledge that it is my responsibility to ensure my child’s safety before and after programming. I hereby release Career Trek Inc. from all liability for any harm or injury suffered by my child, however the harm or injury is caused. I hereby authorize Career Trek Inc. to seek emergency medical assistance for my child if the parents/guardians or emergency contact cannot be contacted. Career Trek Inc. photographs/interviews participants for administrative and promotional reasons. The administrative reasons for photographing participants include health, safety, and identification. I understand that photographs of my child may be taken and used for the administration reasons noted above. The promotional reasons for photographing participants include: raising awareness of Career Trek through advertising and marketing activities (news stories, paid advertising, print materials, and graduation materials). I have read, understand, and agree to the above.*YesNoI hereby authorize Career Trek Inc. and its designated partners to take, store, and use photographs/interviews of the participant for promotional purposes.*YesNoName of Parent/Guardian:*Please type your name. This will be used in lieu of a signature. Commitment Contract for Participants and FamiliesPARTICIPANTS If you are selected to be part of the CRAVE project, we need to know that you would be committed and agree to what is expected of you as a participant of this program. By signing this contract you are agreeing to the rules and expectations of the CRAVE project. •I promise to respect all the rules, participants, staff members, and volunteers while part of the CRAVE project •I promise to attend (virtually or in person) to every program day as long as I am not sick or have a family commitment that day •I promise to be responsible in informing Career Trek when I know that I am going to be absent •I understand that if I do not keep my promises, Career Trek can remove me from the CRAVE project Name* First Last Date* Date Format: MM slash DD slash YYYY *Yes, I understand and agree to the conditions listed above.In a few sentences, share why you wish to be part of the CRAVE project.*FAMILIES Career Trek has programming and initiatives designed to encourage the participant along their career development journey. Supportive family relationships play an important role in a child’s success and we need your commitment in making this a successful experience for them. By signing this contract you are agreeing to the rules and expectations of the project, should the child be selected to be part of the CRAVE project. •Our family promises to ensure that our child attends (virtually or in person) every scheduled programming day •Our family promises to ensure that our child informs Career Trek when they cannot attend a programming day •Our family understands that if we do not keep our promises, Career Trek can remove our child from the CRAVE project Name* First Last Date* Date Format: MM slash DD slash YYYY *Yes, I understand and agree to the conditions listed above.