Planning Major Exchange Tasks

tasK #1 – ParticiPant registration PacKage

• Participant Registration • Participant Agreement • Parental Consent • Medical Information • Waiver of Liability and Consent • Host Family Reference List (see TASK #2) Past Group Organizers recommend participants submit a deposit with their Participant Registration package. all forms collected as part of the Participant Registration should be kept by the group Organizer in a secure and accessible location throughout the exchange. This includes copies of original forms sent to SEVEC.

tiPs on ParticiPant registration PacKage

COMPLETION, STORAGE AND USAGE

1. at the first meeting with youth and their parents communicate clear deadlines for submission of all package contents.

2. Decide with other exchange organizers:

• who will be responsible for collection of documents • who will follow up with late documents

• where documents will be stored (originals as well as copies of those originals sent in the mail) • how originals will be stored (binders, individual files in a file box) as well as how they will be sorted

(alphabetically by form type or all forms for each child together)

3. It is important that all participants and their parents understand that the FIRSt and LaSt names on registration documents must match exactly the documents the youth will be using to travel (passport, birth certificate). Please do not include middle names.

4. It should be stressed to youth participants that what they submit in the registration package should reflect who they truly are as individuals as it is used to twin them for the exchange. Accurate information will assist Group Organizers in providing the best twinning experience (especially the Participant Registration Form).

5. Group Organizers should communicate with their twin on the selection criteria that is being used for twinning purposes. Some groups create additional forms to assist them with creating matches but previous groups have found it easier when they both used a consistent form.

to be completed by parent/guardian and individual participant and submitted to the Group Organizer. Can be sent to twin Group Organizer for youth twinning purposes. do not send to sevec.

participant reGistration

Group Name: ____________________________________________________ Participant Name: _________________________________________________ Address: _________________________________________________________ City: ___________________ Province: _____ Postal Code: ___________ Telephone: ( )___________________________________________ Email Address: ____________________________________________________ School: __________________________________________________________ M F Date of Birth: (mm/dd/yyyy)______ / ______ / __________ Name of Father/Guardian: (living at home) ___________________________________________________________ Work Telephone: ( ) _____________________________________________________________________ Name of Mother/Guardian: (living at home)__________________________________________________________ Work Telephone: ( ) _____________________________________________________________________ Emergency Contact During the Exchange: ___________________________________________________________ Telephone: (home) ( ) ________________________ (work) ( ) ____________________________

to be siGned bY a parent/Guardian oF tHe participant

I am fully aware of all conditions of participation and I support the application my child has made to take part in SEVEC Youth Exchanges Canada. If this application is accepted, I agree to host the participant with whom my child is twinned and provide accommodation, meals and transportation for him/her for the duration of the exchange.

I have filled out the host Family References form and provided the names of three family references and understand that at least two of them will be contacted if reference checks are used in the screening process. I am unable to provide three family references and request a personal interview with the Group Organizer. I understand that any sensitive information in this application will remain confidential.

___________________________________________________ _______________________________

Signature of Parent/Guardian Date

Please note: Participant Registration and Family registration documentation is highly personal and confidential in nature. For this reason it should be stored in a secure location where access is limited to the Group Organizer and/or the principal or Organizational head.

Participant Name: ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––

Hosting inFormation

• Please list all the people living in the hosting household and describe their relationship within the household (e.g. brother, father-in-law, etc.) If there are adults not related to the family living in the home please describe the situation: ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– • Our family can host a: female male either, if a twinning is otherwise not possible none • Language(s) spoken at home: –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– • Our twin will have a separate room: yes no, he/she will share a room with

Your twin must have a separate bed.

• At least one of our household members smokes: no yes

if yes, we/they are willing to smoke outside during the hosting period: yes no yes if a twinning is otherwise not possible

• Our twin can smoke in our house: no yes outside our house only neither • We have animals at home: no yes specify: ––––––––––––––––––––––––––––––––––– • We are prepared to take into account any special dietary needs my twin has: no yes • We are prepared to take into account any manageable medical needs my twin has: no yes • We are prepared to take into account any manageable physical restrictions my twin has: no yes • We are prepared to take into account any allergies my twin has: no yes

Please note: a parent must be present in the home during the hosting period.

visiting inFormation

• My child/I must be twinned with a person of the same sex:

not necessarily yes no if a placement is otherwise not possible

• My child smokes: no yes If yes, your child must be willing not to smoke while being hosted • My child can go to a home where someone smokes: no yes

• My child can go to a home where there are animals: no yes (exceptions)

• My child has special dietary needs: no yes (specify) ––––––––––––––––––––––––––––––––––– • My child has a medical/physical condition that requires medication/special treatment:

no yes (specify)–––––––––––––––––––––––––––––––––––

• My child can take prescribed medication without supervision: no yes (specify) ––––––––––––––––––– • My child has a physical condition that restricts my activities: no yes (specify) –––––––––––––––––––– • My child is allergic to: dust animals molds smoke other (specify) –––––––––––––––––––– ––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––

Signature of Parent(s)/Guardian(s) Date

Please note: Participant Registration and Family Registration documentation is highly personal and confidential in nature. For these reasons it should be stored in a secure location where access is limited to the Group Organizer and/or the principal or Organizational head.

to be completed by parent/guardian and individual participant and submitted to the Group Organizer. Can be sent to twin Group Organizer for youth twinning purposes. do not send to sevec.

to be completed by individual participant and submitted to the Group Organizer. Can be sent to twin Group Organizer for youth twinning purposes. do not send to sevec.

participant reGistration

The main reason I want to go on this exchange is: ____________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ List some of your favourite free-time and weekend activities (indoors and outdoors): ______________________ _________________________________________________________________________________________________ List some of your favourite movies/tv shows and/or music: ____________________________________________ _________________________________________________________________________________________________

interests and activities:

• I like to spend time with my friends: a lot quite a bit not much hardly ever never • I like to spend time on my own: a lot quite a bit not much hardly ever never • I like to read: a lot quite a bit not much hardly ever never

• I like to watch TV: a lot quite a bit not much hardly ever never • I like to be busy: a lot quite a bit not much hardly ever never

• I like to be physically active: a lot quite a bit not much hardly ever never • I like to be outside: a lot quite a bit not much hardly ever never

• I play the folllowing sports: Martial arts hockey ringette soccer football baseball basketball volleyball other (specify) _______________________

• I am interested in: dance choir karaoke musical instrument (specify)_____________________ photography other (specify) _______________________

• I like the following kinds of music: rock country rap hip hop pop

heavy alternative blues jazz classical other (specify) _______________________ • My favourite tech activities are: cell phone texting e-mailing facebook

x-box nintendo blogging other (specify) _______________________

Describe yourself in a sentence or two: ______________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________

language exchanges

• I am taking French as a second language at school: no yes If yes Core French French Immersion

• My parent(s) can speak French as a second language: very well well a bit not at all ___________________________________________ ________________________________

Signature of Participant Initials of Parent(s)/Guardian(s) Please note: Participant Registration and Family Registration documentation is highly personal and confidential in nature. For these reasons it should be stored in a secure location where access is limited to the Group Organizer and/or the principal or Organizational head.

to be completed by participant and parent/guardian and submitted to the Group Organizer. Group Organizer to retain on file. do not send to sevec.

participant aGreement – appropriate beHaVior

Group Name: ____________________________________________________________________________________ Name of Participant: ______________________________________________________________________________

(Please print)

It is important that all participants understand their personal responsibilities and conduct themselves in a respectful and responsible way at all times. By signing this form you are agreeing to all of the conditions of participation in the program.

Please check off ( ) , sign and return to your Group Organizer.

I am ready and willing to participate fully in all aspects of this exchange.

I understand the different responsibilities I have as a host for my twin and as a guest in the home of my twin. I will attend all organized group activities with my twin in both locations and we will not leave the site of

any activity without the permission of the Group Organizer.

I understand that vandalism in any form, shoplifting, possession and/or use of alcoholic beverages and/ or illegal drugs will not be tolerated and I agree to respect the Code of Conduct established by the group Organizer for the duration of the exchange.

I understand that if I do not respect the Code of Conduct, I may lose the privilege of participation in this program. I may not be allowed to continue to participate in any activities of the exchange or, if I am in the exchange destination at the time, I may be returned home at my parents’ risk and expense. In addition, I may be required to reimburse any expenses undertaken by the Group Organizer or SEVEC on my behalf.

I have read, understand and agree to the conditions listed above.

___________________________________________________ _______________________________

Signature of Participant date

___________________________________________________ _______________________________

Signature of Parent(s)/Guardian(s) Date

IN ADDITION TO THE PARTICIPANT, A PARENT/GUARDIAN IS ALSO REqUIRED to sign tHis Form even iF tHe ParticiPant is over 18 Years oF age.

to be completed by participant’s parent(s)/guardian(s) and submitted to Group Organizer. Group Organizer to retain on file. do not send to sevec.

parentaL consent

Group Name: ____________________________________________________________________________________ Name of Participant: ______________________________________________________________________________

(Please print)

In consideration of my child’s participation in SEVEC Youth Exchanges Canada, I agree to the following conditions:

1. I confirm that my responsibilities as a host parent have been explained to me and that I am willing to undertake this responsibility and will receive as a guest in my home a child of approximately the same age as my own child, with all of the privileges and responsibilities which this entails. I agree to provide adult supervision and take full responsibility for our guest while they are hosted in in my home and expect the host parents of my child to do the same during their stay in the other province/territory. I understand that host family screening is mandatory for participation in this national exchange program and I will take part in the specific procedures put in place by the Group Organizer in this regard.

2. I authorize medical attention for my child if judged necessary by the medical authorities of the host province/territory, the Group Organizer or the host family in the case of an accident or serious illness. I understand that every attempt will be made to reach me by telephone in case of an emergency. 3. I understand that my child (or myself) may have the opportunity to express himself/herself verbally or in

written form, appear in photographs and/or video recordings at any point during the SEVEC program, individually or as part of the group. My signature gives SEVEC, their funders and associated partners permission, without receipt of payment or other conditions, to release and/or publish these statements, photographs and/or video recordings for educational and promotional purposes, such as on SEVEC’s website, in a way that does not identify my child.

4. I understand that if my child does not respect the Code of Conduct previously agreed to and the group Organizer finds their behaviour unacceptable, my child may be asked to leave the program, and if this occurs in the exchange destination, may be sent home at my risk and cost. In this event, I hereby release and discharge and further agree to indemnify SEVEC, its employees and agents from all costs and risks incurred in returning my child home from the moment of withdrawal and from all claims which may hereafter be brought against any of them by me or on behalf of my child as a result of such withdrawal.

For groups travelling by air:

I have been informed of the air travel Cancellation Policy and the financial implications of an unused ticket.

___________________________________________________ _______________________________

Signature of Parent(s)/Guardian(s) Date

IN SIGNING THIS FORM, YOU ARE GIVING YOUR PERMISSION FOR YOUR CHILD to ParticiPate in sevec YoUtH excHanges canada and agreeing

to be completed by participant, parent(s)/guardian(s) and submitted to Group Organizers. Group Organizer to retain on file. do not send to sevec.

medicaL inFormation and treatment reLease

In order help ensure the appropriate safety and care of your son/daughter during this exchange, accurate and complete medical information is essential. Medical information is confidential and will be available only to the Group Organizer responsible for the participant, and a physician, if necessary. The parent/guardian assumes full responsibility for the participant’s health, being such that the program activities will in no way aggravate any condition present and will ensure that the participant takes their health services card on the exchange.

Name of Participant: ________________________________________ Date of Birth: _______________________ Home Address: ___________________________________________________________________________________ Home Phone: ( ) ______________ Parent/Guardian Work Phone: ( ) _______________________ Emergency Contact: (other than parent/guardian) ____________________________________________________ Relationship to Participant: _________________________________________________ _______________________ Home Phone: ( ) _____________________________ Work Phone: ( ) _______________________ Family Doctor’s Name: ____________________________________________________________________________ Family Doctor’s Phone: ( ) __________________________________________________________________ Provincial/Territorial Health Card Number: ___________________________________________________________

Personal HealtH record

1. Please check any of the following conditions which the participant is subject to:

asthma bed wetting boils bronchitis

convulsions diabetes ear trouble eczema

epilepsy eye trouble fainting frequent colds

motion sickness nightmares sinus trouble skin condition

kidney sleepwalking tonsillitis

2. Please give details of the usual treatment should any conditions indicated above occur.

_____________________________________________________________________________________________ 3. Please check any of the following allergies which the participant is subject to:

anesthetic animals drugs dust

foods insect stings penicillin plants

pollen other _______________________________________________________________ Please give details of the signs/symptoms and appropriate treatment.________________________________ _____________________________________________________________________________________________ 4. Any other chronic condition of which Group Organizers should be aware?

no yes Please specify and give details of any medication necessary._______________________ _____________________________________________________________________________________________ 5. Please check any of the following illnesses which the participant has had:

appendicitis chicken pox fifth disease german measles

heart disease Jaundice measles mononucleosis

mumps pleurisy pneumonia poliomyelitis

rheumatic fever scarlet fever tuberculosis whooping cough 6. any illness, disability, physical or emotional situation (recent death of immediate family member,

separation, divorce, etc.) not included on this list that might prevent full participation?

7. Recent operations/injuries (give dates and nature) _______________________________________________ Precautions that have been advised ___________________________________________________________ 8. Has the participant had a dental examination within the last six months? no yes

9. Are all vaccinations up to date? no yes 10. Is the participant a vegetarian? no yes

Please indicate any special dietary requirements ________________________________________________ 11. Is the participant currently taking any medication? no yes

name of drug ________________________________________________________________________________ Condition for which the drug was prescribed _____________________________________________________ dosage ______________________________________________________________________________________

Please be certain that your child has all the necessary medication required for the length of the exchange.

12. Can the participant take medication without supervision? no yes If no, who will be responsible? (clear written instructions must be provided in advance) _____________________________________________________________________________________________ _____________________________________________________________________________________________ As the parent/guardian of the participant, under circumstances as stated below, I hereby authorize the Group Organizer to secure such medical advice and treatment as may be deemed necessary for the health and safety of my child. __________________________________________________ (Please print participant’s full name)

1. Where medical advice has been such that further services are required and such services require the consent of a parent/guardian

2. Where all attempts to contact the parent/guardian have failed or where, due to the nature of the emergency there is insufficient time to contact such parent or guardian

I understand that costs over and above those covered by my provincial/territorial health plan may be claimed under the group accident insurance policy covering SEVEC participants.

___________________________________________________ _______________________________ Signature of Parent(s)/Guardian(s) Date ___________________________________________________ _______________________________ Name of Parent(s)/Guardian(s) (Please Print) Date Please note: Participant Registration and Family Registration documentation is highly personal and confidential in nature. For these reasons it should be stored in a secure location where access is limited to the Group Organizer and/or the principal or Organizational head.

note:

to be completed by participant and parent/guardian as well as adult chaperones. submit to group Organizer. original documents to be mailed to sevec by group organizertwo months after the confirmation of your exchange.

WaiVer oF LiabiLitY and consent Form

Group Name: __________________________________________________ SEVEC Project Number:_____________ *Name of Participant (youth or chaperone): _________________________________________________________ *(use full name as per the identification tag being used to travel) (Please print)

Waiver oF liaBilitY

In consideration of my participation in SEVEC Youth Exchanges Canada funded by the Society for Educational Visits and Exchanges in Canada (hereinafter “SEVEC”) and Her Majesty the Queen in Right of Canada as represented by the Minister of Canadian Heritage (hereinafter “Her Majesty”), I hereby irrevocably agree that I will make no claim against SEVEC and/or Her Majesty with respect to any claim of whatever kind or nature whether for personal injury or damage, damage to property or for contribution and indemnity or otherwise, and I hereby fully and forever waive any common law, civil law or statutory rights I may have to make any such claim or claims. I further agree not to make any claim or claims against anyone that may make a claim for contribution and indemnity against SEVEC or Her Majesty. Notwithstanding the above, this waiver of liability does not apply to a claim arising from the negligence of SEVEC, Her Majesty or their respective employees and agents.

consent to tHe collection and Use oF Personal inFormation

I hereby give my consent for SEVEC to collect the personal information required for participation in the SEVEC Youth Exchanges Canada Program. I understand that this personal information is required for the purposes of program delivery and that it will only be used by SEVEC or disclosed to selected third parties who are acting as suppliers, service providers or who provide funds to SEVEC and who have agreed to protect the personal information supplied by SEVEC.

I understand that my child (or myself) may have the opportunity to express himself/herself verbally or in written form, appear in photographs and/or video recordings at any point during the SEVEC program, individually or as part of the group. My signature gives SEVEC, their funders and associated partners permission, without receipt of payment or other conditions, to release and/or publish these statements, photographs and/or video recordings for educational and promotional purposes, such as on SEVEC’s website, in a way that does not identify my child.

For ParticiPants Under tHe age oF 18

I consent to the participation of ________________________________________________________ (Please print participant’s full name per identification)

in SEVEC Youth Exchanges Canada and I further consent to and adopt the contents of the above Waiver of Liability and Consent to the collection and use of personal information.

___________________________________________________ _______________________________ Signature of Parent(s)/Guardian(s) Date ___________________________________________________ _______________________________ Name of Parent(s)/Guardian(s) (Please Print) Date or ___________________________________________________ _______________________________ Signature of the participant (youth or chaperone) over age of 18 date

to be completed by the host family and submitted to the Group Organizer. The original document must be submitted to SEVEC two months after the confirmation of your exchange.

Host FamiLY reFerences

Name of Participant: ____________________________________________ SEVEC Project Number:_____________ Name of Group (school or organization): ____________________________________________________________ the reciprocal home stay is an integral part of SEVEC exchanges and fundamental to the experiential learning process. opening your home to one of the participants from another province provides this young person with an opportunity to immerse themselves in the culture of the local community, thereby improving their understanding and knowledge of Canada, fostering an appreciation of diversity and helping participants to better connect with their twin.

As the organizing body, it is necessary for SEVEC to ensure that all participants going on an exchange have safe and suitable accommodations during their time in the host community. therefore, it is mandatory for every potential host family to participate in the screening process.

all families who wish to host during the exchange, will be required to submit three suitable references. criteria for references:

1) has known your family for at least three years.

2) has been in contact with your family within the last 6 months. 3) Is not related to your family in any way.

4) Is a person you feel comfortable asking to be a reference for you. 5) Must be 18 years of age or older

Please complete all requested fields of information for all three of your references. Be prepared to have two of the three references contacted during the screening process.

reFerences – FuLL addRESSES REQuIREd

Name: ___________________________________________________________________________________________ City & Province: __________________________________________________________________________________ Home or Cell Phone Number: ______________________________________________________________________ Work Number (optional): __________________________________________________________________________ Relationship to the Family: _________________________________________________________________________ Name: ___________________________________________________________________________________________ City & Province: __________________________________________________________________________________ Home or Cell Phone Number: ______________________________________________________________________ Work Number (optional): __________________________________________________________________________ Relationship to the Family: _________________________________________________________________________ Name: ___________________________________________________________________________________________ City & Province: __________________________________________________________________________________ Home or Cell Phone Number: ______________________________________________________________________ Work Number (optional): __________________________________________________________________________ Relationship to the Family: _________________________________________________________________________ Please note: host family screening documentation is highly personal and confidential in nature for these reasons it should be stored in a secure location where access is limited to the Group Organizer and/or the principal or Organizational head. Name: ________________________________________________________________ City & Province: ________________________________________________________ Home or Cell Phone Number: ____________________________________________ Work Number (optional): ________________________________________________ Relationship to the Family: _______________________________________________ Joe Jones Ottawa, On 613-123-4567 neighbour exam P le :

Name: ________________________________________________________________ City & Province: ________________________________________________________ Home or Cell Phone Number: ____________________________________________ Work Number (optional): ________________________________________________ Relationship to the Family: _______________________________________________

to be completed by the Group Organizer or another adult helping with the exchange, and signed by the Group Organizer. The original documents to be mailed to SEVEC two months after the confirmation of your exchange. KeeP coPies on File.

Host FamiLY reFerence cHeck

SEVEC Project Number: ____________ Date:______________ Name of Interviewer: ________________________ Name of Host Family: _____________________________________________________________________________ Name of Participant: (if different from host family name) _______________________________________________ Name of Reference: _______________________________________________________________________________ Please contact two of the references listed on Host Family reference Form for each potential host familiy and ask them the following questions. Contact with a reference includes a telephone call, or a personal visit. this form should not be mailed/given to the references to complete and return on their own.

(1) Please use a separate reference check form for each reference interviewed. (2) two per hosting family are required.

(3) all answers and signatures must be originals.

1. how long have you known the family and in what capacity do you know the family? (reminder: Must be a minimum of 3 years and family members may not be references)

______________________________________________________________________________________________ 2. When were you last in contact with the family? (reminder: Must have been within the last 6 months) ______________________________________________________________________________________________ 3. In your opinion, is the family able to provide adequate supervision and to take full responsibility for the

visiting exchange participant in their care?

______________________________________________________________________________________________ 4. In your opinion, is the family able to provide accommodation, (personal sleeping space, adequate toilet

facilities), meals and snacks, and arrange local transportation as necessary for their visitor?

______________________________________________________________________________________________ 5. do you have any reason to think that any member of this family has problems with drugs or alcohol? ______________________________________________________________________________________________ 6. have you any reason to believe that any member of the family may be abusive, verbally or physically with youth? ______________________________________________________________________________________________ 7. Would you feel comfortable placing your own children in this family’s home for a week or more? ______________________________________________________________________________________________ 8. are you able to recommend this family as a host family for sevec Youth exchanges canada?

______________________________________________________________________________________________ decision:

this family Will host. or

___________________________________________________ _______________________________

Signature of Interviewer date

___________________________________________________ _______________________________ Signature of Group Organizer (If different from interviewer) Date Please note: Host family screening documentation is highly personal and confidential in nature for these reasons it should be stored in a Secure location where access is limited to the Group Organizer and/or the principal or Organizational head and destroyed after the exchange.

reminder:

To be completed by the Group Organizer or another adult helping with the exchange, and signed by the Group Organizer. The original documents to be mailed to SEVEC two months after the confirmation of your exchange. KeeP coPies on File.

Home Visit

SEVEC Project Number: __________________ Name of Interviewer (print): _______________________________ Name of Host Family: _____________________________________________________________________________ Name of participant (if different from host family name): _______________________________________________ Please contact the potential host Family to set up a date and time to visit. SEVEC recommends that you allow 15-30 minutes for each visit. on the day of the visit SEVEC recommends that you bring this form with you to act as guide as to what you should be looking for and the questions you should be asking.

For privacy reasons, please complete this form after the visit. NOTE: All answers and signatures must be originals.

1. Do you know this family? If so how long and in what capacity?

_______________________________________________________________________________________________ 2. In your opinion, is the family able to provide adequate supervision and to take full responsibility for the

visiting exchange participant in their care?

_______________________________________________________________________________________________ 3. In your opinion, is the family able to provide accommodation (personal sleeping space, adequate toilet

facilities), meals and snacks, and arrange local transportation as necessary for their visitor? _______________________________________________________________________________________________ 4. Do you have any reason to think that any member of this family has problems with drugs or alcohol? _______________________________________________________________________________________________ 5. Have you any reason to believe that any member of the family may be abusive, verbally or physically with youth? _______________________________________________________________________________________________ 6. Do you have any concerns around cleanliness and hygiene that might affect the exchange? _______________________________________________________________________________________________ 7. Would you feel comfortable placing your own children in this family’s home for a week or more? _______________________________________________________________________________________________ 8. Are you able to recommend this family as a host family for SEVEC Youth Exchanges Canada? _______________________________________________________________________________________________ DECISION:

this family Will host. oR this family Will not be hosting.

___________________________________________________ _______________________________

Signature of Interviewer date

___________________________________________________ _______________________________ Signature of Group Organizer (If different from interviewer) Date

Please note: host family screening documentation is highly personal and confidential in nature. For these reasons, it should be stored in a secure location where access is limited to the Group Organizer and/or the Principal or Organizational head.