1. sports
2. boxing

FOXY Peer Leader Retreats
July 23-31, 2015 and August 6-14, 2015 at Blachford Lake Lodge, NWT
Fostering Open eXpression among Youth (FOXY) is excited to host two week-long Peer Leader Retreats
this year at Blachford Lake Lodge! We are looking forward to doubling the number of girls we’re able to
work with this summer. In this registration package, you’ll find information for young women, their
parents, and teachers about the FOXY Peer Leader Retreats. Please review all of the attached information,
then complete the forms and return them to FOXY. Send us an email (retreat@arcticfoxy.com), message
us on the FOXY Facebook page (facebook.com/ArcticFoxyNWT), or give us a call (867-444-9108) if you
have any questions about the Retreat.
All expenses for participants, including travel from their home communities to Yellowknife is
covered through the generous support of the Public Health Agency of Canada, the Arctic
Inspiration Prize, and our other sponsors.
Young women aged 13-17 from across the NWT are invited to join the FOXY team for a week of sexual
health education, learning about healthy relationships, the arts, leadership, and self-empowerment.
Previous experience with the arts or artistic talent is not required, but we hope you will enjoy expressing
yourself through drama, music, traditional arts, and photography! While the emphasis will not be on
strenuous activity, participants should be in reasonably good health and be prepared to spend time outside
and engage in physical activities like hiking, swimming, etc.
Becoming a FOXY Peer Leader means that young women will be expected to be role models in their
home communities after participating in the Retreat. All participants will plan and deliver a Community
Project in their hometown after the Retreat. The goal of the project is to address a problem that the
participant cares about, so applicants should feel comfortable with this idea. They will be given lots of
support, but they will be expected to lead and complete the project this fall.
Note To Parents, Guardians, & Teachers:
Thank you for helping the young women in your life learn about FOXY and think about whether the
FOXY Peer Leader Retreat is a good opportunity for them. We’re really excited about the program, but we
acknowledge that not every person is comfortable engaging with the arts, or expressing themselves in the
ways that we do at FOXY. We look forward to hearing from your daughters, sisters, nieces, students, and
friends, and ask that you allow them to complete the registration package as independently as possible. We
want to see their handwriting, their spelling errors, and their personality come through in the application!
When discussing the FOXY Peer Leader Retreat with a potential applicant, please make sure to mention
the following things. We want every participant to know about the expectations of FOXY Peer Leaders,
and to be excited to learn about stuff like:
•
•
Photography;
Traditional arts (drum circles, smudging, beading);
1
•
•
•
•
Drama;
Sexual health education;
Music, singing, and song-writing; and
Community projects that the participant will complete when they return home.
FOXY is thrilled that all Peer Leader Retreat participants now earn 2 high school credits for their active
participation in the Retreat, and an additional 2 high school credits for completing their community
project!
Blachford Lake Lodge is an internationally acclaimed fishing lodge, and we experience all of these arts and
activities in a beautiful outdoor environment, but FOXY is not an outdoor adventure camp. Participants
who are seeking on-the-land skills will not find what they’re looking for at FOXY (although we welcome
everyone and try to make sure everyone has fun, of course!).
All participants will spend time during the Retreat planning a Community Project that they will be
responsible for delivering, with help from a mentor they choose, when they return to their home
communities. The FOXY team will provide resources to assist with the planning, and will help connect the
Peer Leader with a teacher support when they return home, but the Community Project is participantdirected. Please discuss this idea with the applicant, and make sure that they are comfortable with it. They
won’t be working on it alone, but they will be the boss!
Community Projects don’t need to be intimidating or huge, and the emphasis is on the leadership process
over the actual result. Examples of past projects include:
• Volunteering at a kids’ healthy living program to lead exercise routines for 5-8 year olds;
• Starting a paper recycling program at an elementary school;
• Coordinating a dance to benefit survivors of an international disaster; and
• Setting up a space in a high school for students to access free resources about sexual health.
After the Retreat, please ask the participant to review the Community Project book that they will receive.
Parts of it are private reflections on their Retreat experience, but the book is also meant to guide the
completion of the Community Project. You may wish to volunteer to help them out with their project!
If you require further information or have any questions, please see our website at www.arcticfoxy.com
or contact Candice Lys (FOXY Executive Director) at retreat@arcticfoxy.com or (867) 444-9108.
APPLICATION DEADLINE: MAY 31, 2015
(All applications must be emailed, faxed, or received via mail by this date)
Completed applications may be scanned and emailed to retreat@arcticfoxy.com,
faxed to 1-888-518-4945 (toll-free), or mailed to:
FOXY
240 Borden Drive
Yellowknife, NT X1A 3R4
Emails will be sent to applicants & their parents/guardians to confirm all applications received.
Contact us before the May 31st deadline if you have not received your confirmation!
SPACE IS LIMITED, SO APPLYING DOES NOT GUARANTEE ACCEPTANCE –
WE WILL CONTACT ALL APPLICANTS WITHIN TWO WEEKS AFTER THE DEADLINE!
2
FOXY Peer Leader Retreat Schedule (subject to change):
Retreat #1: Thursday, July 23, 2015 (Day 1) – Friday, July 31, 2015 (Day 9)
Retreat #2: Thursday, August 6, 2015 (Day 1) – Friday, August 14, 2015 (Day 9)
Day 1
• Participants arrive in Yellowknife from their home communities
• Participants and facilitators spend the night at a team sleepover at the Yellowknife Ski Club
Day 2
• Participants and facilitators leave for Blachford Lake Lodge at 9 am via float planes
• Participants arrive at Blachford, get settled and eat lunch before doing an orientation and getting
started on camp activities!
Day 3 – Day 7
• Participants take part in art projects, outdoor activities, sexual health education and empowerment
activities, enjoying wonderful hospitality from the Blachford Lake Lodge staff, and planning their
Community Projects
Day 8
•
•
•
•
•
Participants spend the morning presenting their community project plans to the group
After lunch, everyone packs and gets ready to leave
Over supper, we give out our Camp Awards
At 7pm, we get onto the planes and return to Yellowknife
All participants and facilitators go to Yellowknife Ski Club for a team sleepover
Day 9
• Participants return to their home community. We'll miss you!
3
IMPORTANT THINGS TO KNOW
•
At Blachford, you will be sharing a room with at least one other person. If you have any concerns
about this, or would like to make any special requests, please contact us in advance.
•
At the FOXY Peer Leader Retreat, smoking, drinking, and drugs are strictly prohibited.
Please leave these items at home so they don't get confiscated and jeopardize your chance
to stay at the Retreat.
•
We will make all attempts to accommodate special medical, nutritional, and personal needs. Please
be honest about your needs and we will work with you as much as possible to make sure that you
have the best time at the Retreat!
•
During the two evenings we are spending in Yellowknife, all participants and facilitators must
remain at Yellowknife Ski Club for the duration of the sleepovers as these are teambuilding activities that are central to the FOXY Peer Leader Retreat. There will be no
exceptions made.
•
During our time at Blachford Lake Lodge, participants will not be able to leave for any reason
outside of an emergency. If a participant must be removed from the site for disciplinary
reasons, the cost of the flight charter will be forwarded on to the participant's family.
•
Mealtimes will be at 9am (breakfast), 1pm (lunch), and 6pm (supper).
•
All successful participants in the FOXY Peer Leader Retreat will receive 2 Grade 10-level credits in
the NWT school system. The Peer Leader Community Projects are worth 2 Grade 11-level credits
if they’re completed!
•
Electronics/Internet Policy: FOXY strongly discourages you from bringing your phone or
device to the Retreat – we don’t have cell service anyway, and the limited wireless Internet
is exclusively for the use of the Blachford Lake Lodge staff for business purposes. Wireless
Internet MAY be turned on in the lodge twice each day for approximately a half hour at a time for
personal Internet use. If Internet use becomes an issue negatively affecting the Retreat
environment, the Electronics/Internet policy may be modified at the discretion of the FOXY
Executive Director (Candice Lys). If you are concerned about your device getting lost or damaged,
please leave it at home. We’ll be super busy anyway doing fun things, and many past participants
found that they enjoyed being free from their electronic devices during the Retreat! To help
prevent loss, damage, and/or theft, all devices must be left with FOXY staff in the main
lodge while the Internet is not available.
4
PACKING LIST
*Blachford is a premiere lodge, but some activities will be outside and everything will take place in a rustic
environment. Please do NOT bring anything that you will be upset about if it gets damaged/lost!
*This is a suggested packing list, but remember that all of our accommodations will be shared, and you'll be
responsible for keeping track of all of your belongings. Most of what you need will be provided. Please
pack light, or contact us if you are unsure of something that you want to bring.
*Please make sure that your baggage is within the weight limit of your flights to Yellowknife (around
30lbs).
*Even though it will be summertime, please remember that it can get chilly at night!
•
•
•
•
•
•
•
•
•
•
•
•
•
T-shirts (4-5) - plus FOXY t-shirts/hoodies
if you already have them!
Jeans/outdoor-appropriate pants (2-3
pairs)
Shorts
Pyjamas
Bathing suit
Sunhat/ball cap
Hoodie
Underwear (8-10 pairs) & 2 bras
Socks (8-10 pairs)
Shoes
o Sandals
o Walking/light hiking shoes
Wind & rain-proof jacket & pants
Bug jacket
Toiletries
o Shampoo/conditioner
o Face wash/moisturizer
o Soap
o Toothbrush/toothpaste
o Nail clippers, tweezers, etc.
o Lip balm
o Glasses cleaner & case, contact
solution, cases & spare contact
lenses
o Sunscreen & insect repellent
o Hairbrush
•
•
•
•
•
•
•
•
5
Any medications, in a plastic bag marked
with doses/instructions
Sunglasses
Camera and battery charger
Daypack/backpack
Water bottle (reusable and marked with
your name!)
Flashlight
A book
Sleeping bag, pillow, and (optional) small
foamie or air mattress (these will all stay in
Yellowknife when we go out to Blachford
– so pack them separately from the rest of
your gear!)
REGISTRATION FORM A – PARTICIPANT & CONTACT INFORMATION
Participant:
Full Name (on ID): __________________________ Name used: ______________________
Age (on July 23, 2015): ______ Grade (in Sept. 2015): _______ Date of Birth: _____________
Mailing Address: _____________________________________________________________
Phone: (h) __________________ (c) _____________________ Hoodie Size: _____________
Email: __________________________ Best way to contact me is: _____________________
I am applying for: ___ Retreat #1 (July 23-31) OR ___ Retreat #2 (August 6-14)
OR ___ Either
Parent/Guardian #1 (Main contact):
Name: ___________________________ Relation to Participant: ______________________
Home Address: _____________________________________________________________
Mailing Address (if different from home): _________________________________________
Phone: (h) __________________ (w) ____________________ (c) _____________________
Email: _________________________________ **Main method of contact for FOXY
Parent/Guardian #2:
Name: ___________________________ Relation to Participant: ______________________
Home Address: _____________________________________________________________
Phone: (h) __________________ (w) ____________________ (c) _____________________
Email: _________________________________ **Main method of contact for FOXY
Emergency Contact during Peer Leader Retreat (if Parents/Guardians cannot be reached):
Name: ___________________________ Relation to Participant: ______________________
Home Address: _____________________________________________________________
Phone: (h) __________________ (w) ____________________ (c) _____________________
School Counsellor Information:
Name: ___________________________ School Name: _____________________________
Phone: ___________________________ Email: ___________________________________
6
REGISTRATION FORM B – PARTICIPANT HEALTH INFORMATION
Full name (on ID): ____________________________ Name used: __________________________
Date of Birth: _________________________ NWT Health Care Number: _______________________
The information on this form may be used by FOXY Staff or medical personnel to administer or authorize
appropriate first aid, health care, or medical attention for the participant. The participant’s health
information is reviewed only by FOXY Retreat staff and medical personnel. It is shared with other adults
on a need-to-know basis in our effort to support her participation. If your daughter/ward has any
disabilities that may require accommodation, disclosing and discussing them with us will help us
accommodate her needs.
Height: ________ Weight: ________
Family Doctor and Name of Clinic: __________________________________________
Month and year of most recent tetanus immunization: _______________
All participants must have current tetanus vaccinations.
The Peer Leader Retreat may include swimming hiking, other outdoor activities, etc. Does the participant
have any physical, cognitive, emotional, or behavioural limitations/challenges that require assistance
and/or modifications to the program to enable her to participate fully? YES _____ NO ______
If yes, please explain: __________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Does the participant know how to swim and are they comfortable in the water? YES ______ NO ______
Provide details of previous swimming lessons/certifications (if applicable): _________________________
___________________________________________________________________________________
Doe the participant have any allergies to medications, insect stings, food, etc.? YES ______ NO _______
If yes, please complete the following:
Allergy
Life threatening?
________________________ YES NO
________________________ YES NO
________________________ YES NO
Allergy
Life threatening?
________________________ YES NO
________________________ YES NO
________________________ YES NO
Please explain details of allergies (symptoms, treatment, etc): ___________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Does the participant carry an Epi-Pen and know how to self-administer during an allergic reaction?
YES _______ NO (no Epi-Pen needed) _______ NOT APPLICABLE (no allergies) _______
Describe any operations or serious injuries (include dates):
___________________________________________________________________________________
___________________________________________________________________________________
7
NAME OF PARTICIPANT: _________________________________
Does the participant have a history of any of the following:
Arthritis ⃝
Motion sickness ⃝
Respiratory Ailments
Convulsions ⃝
Heart Disease ⃝
⃝
Bed Wetting ⃝
Sleepwalking ⃝
Nightmares ⃝ Diabetes ⃝
Kidney Disease ⃝
Ear trouble ⃝
Asthma ⃝
Headaches ⃝
Liver Disease ⃝
Other – please specify
⃝
If yes, please provide details: ____________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Please provide details of any chronic or recurring illnesses or conditions:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
List any medications (name/dose/time administered/etc.) your child/ward will bring to the Retreat:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Will your child/ward be responsible for administering her own medication while at the FOXY Retreat?
YES ______ NO______ NOT APPLICABLE (No medications) _______
Describe any concerns you have related to the participant’s emotional health:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Does the participant wear glasses or contact lenses? YES ______ NO_____
Has the participant started menstruating? YES ______ NO______
If yes, is her menstrual history normal? YES ______ NO______
Do you give permission for the FOXY Executive Director or First Aider to provide non-prescription
medications to your child/ward (acetaminophen (Tylenol) and/or Ibuprofen, Benadryl, Imodium, or
Gravol) if required? YES____ NO_____
Special instructions for the FOXY Staff regarding the participant’s health care and/or diet:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
8
NAME OF PARTICIPANT: _________________________________
Emergency Medical Contact:
Name: _________________________ Relation to Participant: ________________________
Phone: (h) __________________ (w) ____________________ (c) _____________________
Home address: _________________________________________
IMPORTANT: Please notify Candice Lys, FOXY Executive Director (867-444-9108) if the participant is
exposed to any communicable diseases during the three weeks prior to Peer Leader Retreat attendance.
FOXY provides limited insurance coverage for accidents and for illness incurred while attending the Peer
Leader Retreat. It is the responsibility of every participant’s parent or legal guardian to provide for the
participants own accident and health coverage beyond the limits of the basic Peer Leader Retreat coverage.
I hereby give permission to the physician selected by the FOXY staff to order X-rays, routine tests,
and treatment for the health of my child/ward. In the event I cannot be reached in an emergency,
I hereby give permission to the physician selected by the FOXY staff member to hospitalize,
secure proper treatment for, and to order injections and/or anaesthesia and/or surgery for the
individual named above.
This health history is correct so far as I know, and the person herein described has permission to
engage in all prescribed Peer Leader Retreat activities as noted by myself and the child/ward’s
examining physician.
Name of Parent/Guardian: _____________________________________
Signature: ___________________________________________________ Date: __________________
9
REGISTRATION FORM C – PHOTO AND IMAGE WAIVER
In the course of activities during the Peer Leader Retreat, representatives of Fostering Open eXpression
among Youth (FOXY), participants, and staff may take photographs or otherwise record events. Please
advise us if you are willing to have your own image and voice and/or your child/ward’s image and voice
used for promotional purposes by FOXY, as indicated below:
I, on my own behalf and/or on behalf of my child/ward, give permission to FOXY representatives to
photograph and record me and/or my child/ward’s image and voice on still photographs, motion picture
film, audio tape, video tape or digital media and to use this material, and/or similar material provided to
FOXY by me or third parties involved in Retreat events, in whole or in part, now and in the future,
through the media of television, film, Internet, multi-media presentation, radio, audiotape, videotape, in
printed form, and display form for the promotion of FOXY. I, on my own behalf and/or on behalf of my
child/ward assign and transfer to FOXY any and all proprietary rights, including copyright, and waive all
personality rights, which I may have or my child/ward may have in this material.
Fostering Open eXpression among Youth is only responsible for official uses of photographs and
recordings. Any personal uses by individuals outside of the promotional uses outlined above are not
monitored by or the responsibility of FOXY.
I, on my own behalf and/or on behalf of my child/ward give my permission as set out above:
Name of Participant
Signature of Participant
Name of Parent/Guardian
Relationship to Child/Ward
Signature of Parent/Guardian
Date
10
REGISTRATION FORM D – PARTICIPANT INTERESTS
*Participants should fill out the following section alone, without parental or teacher assistance.
There are no right or wrong answers and you cannot “fail” – these will just help us figure out how
FOXY can fit into your life! Please attach another page if you need more space.
Participant Name: _______________________________________ Age: ______ Grade: __________
Have you ever done a FOXY workshop before? YES NO If yes, where? ________________________
If no, what have you heard about FOXY? __________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Why do you want to attend the FOXY Peer Leader Retreat?
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
What are some problems that you think young women in your community have?
___________________________________________________________________________________
__________________________________________________________________________________
___________________________________________________________________________________
What are some ideas you have to make your community a better place?
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
FOXY Peer Leaders are expected to complete a Community Project after the Retreat when they return
home to their communities. How do you feel about this idea?
___________________________________________________________________________________
___________________________________________________________________________________
To help with your community project, you’ll be asked to choose a mentor in your community. Who do you
think this might be? It’s okay if you can’t think of anyone yet, we will help you find someone!
___________________________________________________________________________________
How do you feel about taking photos, writing stories, and creating music?
___________________________________________________________________________________
___________________________________________________________________________________
How do you feel about singing songs and acting things out (like charades, or in a play)?
___________________________________________________________________________________
___________________________________________________________________________________
11