Mistatim Medicine Horse Society 1429 Moonstone Rd Midland, ON

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1 Mistatim Medicine Horse Society 1429 Moonstone Rd Midland, ON The Mistatim Medicine Horse Society is pleased to offer another incredible year of programing for today s youth! What is the Mistatim Medicine Horse Society? The Mistatim Medicine Horse Society is a place that provides an opportunity to reconnect our youth to the land, indigenous culture, and our language, while fostering self-awareness, decision-making and leadership through the teachings of horse medicine. Horses are honest, kind, and they demonstrate sharing and strength. Horses are an important part of our Indigenous culture. In addition, training in horsemanship will further develop team-building, planning skills and problem-solving. Working with horses increases empathy in individuals and promotes responsibility, sharing and caring. Participants who are selected will attend; a two day weekend orientation in the spring and one week long camp. Participants and their families are invited back in the fall to join us for a fun on the farm family day. The camp is hosted by FourWindz Stables, located on over 100 acres of farm land in Simcoe County, near Hillsdale, Ontario. The program will be overseen by a variety of qualified staff. A maximum of twelve participants will be selected per intake. There will be four intakes completed during the summer and fall of 2014, as per enclosed schedule. Participants are asked to provide their own transportation but alternative means are available in special cases. The Mistatim Medicine Horse Program will create a safe place for youth from all cultures to become connected to the land, acquire traditional knowledge, develop leadership skills and learn about inclusivity and equality. Please review the attached information and registration package. To register, please complete forms and to

2 MISTATIM MEDICINE HORSE SOCIETY ELIGIBILITY CRITERIA CHECK LIST Ø ALL PARTICIPATION IN MMHS PROGRAMING IS VOLUNTARY Ø MUST BE OPEN TO LEARNING ABOUT ABORIGINAL CULTURE Ø MUST BETWEEN THE AGES OF 9-19 Ø MUST ADHERE TO ALL TERMS & CONDITIONS Ø MUST IDENTIFY ANY MEDICAL AND/OR PHYSICAL CONDITIONS THAT MAY AFFECT PARTICIPATION I.E. WORKING WITH AND/OR RIDING HORSES, RECREATIONAL GAMES, ALLERGIES Ø MUST BE PREPARED TO LIVE IN WILDERNESS CAMP ENVIRONMENT I.E. NO ELECTRICITY, NO RUNNING WATER, LIMITED SHOWER ACCESS, OUT HOUSES Ø MUST DECLARE ANY ONGOING CRIMINAL CHARGES/PROBATION CONDITIONS THAT MAY AFFECT PARTICIPATION IN THE MMHS PROGRAM Ø MUST IDENTIFY IF BEING REFERRED BY A THIRD PARTY AGENCY Ø REGISTRATION MUST BE COMPLETE IN FULL BEFORE ATTENDING CAMP SLEEPING BAG & PILLOW TOWEL, WASH CLOTHES TOOTH BRUSH, TOOTH PASTE APPROPRIATE CLOTHING o SHORTS, o T-SHIRTS, o LONG PANTS FOR HORSEBACK RIDING, o BATHING SUIT o LONG SKIRT FOR YOUNG WOMEN o SOCKS, SOCKS & MORE SOCKS SOAP/SHAMPOO/CONDITIONER SUNSCREEN AND BUG SPRAY CAMERA HAT/BANDANA OTHER MISCELLANEOUS PERSONAL HYGIENE ITEMS APPROPRIATE FOOTWEAR RUBBER BOOTS, HIKING BOOTS, RUNNING SHOES, RIDING BOOTS (IF YOU HAVE THEM) ETC REGISTRATION PACKAGE (SIGNED WAIVERS) ABSOLUTELY NO ELECTRONIC DEVICES, SUCH AS: o CELL PHONES/PDA S o GAMES/ ANYTHING THAT CONNECTS TO WIFI o MP3 PLAYERS/I PODS UNNECESSARY JEWELRY PERFUME/ COLOGNE PURSE/WALLET/MONEY

3 Mistatim Medicine Horse Society 1429 Moonstone Rd Midland, ON Mistatim Medicine Horse Society Waiver of Liability Here at Four Windz Stables/ The Mistatim Medicine Horse Society we strive to provide our patrons with a safe, enjoyable recreational experience, however there are inherent dangers involved with horseback riding and camping in extreme weather conditions. All Participants must abide by the rules of the stable and the Mistatim Medicine Horse Society Programing. Acknowledgement of Risks I understand and acknowledge that the Mistatim Medicine Horse Society & Four Windz Stables programming and its associated activities generates risk which may result in injury, illness, or property damage to myself, other participants, spectators or other third party agreements. Photo/Video Release I hereby grant to The Mistatim Medicine Horse Society, including its employees, agents, contractors, successors, assigns and licensees, the full right of use of any type of media taken on site and during programing. I agree that Mistatim Medicine Horse has the full right to edit, delete from, arrange, combine, revise or adapt in any manner all or any part of any of the materials and to use the same in any manner which Mistatim Medicine Horse, in its sole discretion, deems appropriate. I hereby release and discharge The Mistatim Medicine Horse Society from any and all claims, demands, or causes of actions that I have or may in the future have for libel, defamation, invasion of privacy or right of publicity, infringement of copyright or trademark, or violation of any other right arising out of or relating to any utilization of the rights granted under this release. Terms & Conditions Absolutely no use of drugs and alcohol or modified tobacco while participating in the Mistatim Medicine Horse program. There will be zero tolerance for any violent or abusive behaviour including bullying and harassment. All participants of the Medicine Horse program must abide by all safety rules and guidelines as outlined in the rules and regulations. While participating in the Medicine Horse program, youth are not to bring and/ or use any electronic devices. Any electronic devices found will be confiscated and returned to the participant at the end of the program. Electronic devices include but are not limited to: Cell phones IPods, MP3s, any music devices Any hand held electronic or gaming device that has capability of connecting to wifi I understand while participating in the Mistatim Medicine Horse program that I must refrain from any and all inappropriate sexual behaviour and activities. I/we,,, have read and understand the terms and conditions for my participation in the Mistatim Medicine Horse program; I also understand that failure to comply with the terms and conditions may result in a bag/ body search as well as withdrawal for the duration of the program. Parents/Guardians will be contacted to arrange for transportation. PARTICIPANT SIGNATURE DATE PARENT/GUARDIAN SIGNATURE DATE

4 MMHS Camp Dates Orientation: May 14 th and 15 th 2016 Camp week: July 3 rd to 9 th 2016 Camp #2 Ages: 8 to 12 Orientation: May 21 st to 22 nd 2016 Camp Week: July 17 th to 23 rd 2016 Camp #3 Ages 8 to 12 Orientation: June 4 th and 5 th Camp Week: August 7 th to 13 th Ages 16 to 18 Orientation: June 11 th and 12 th Camp Week: August 21 st to 27 th MMHS Events and Activities Family Fun Day February 15th am-3pm Children 0-12 and their families are welcome. Join the Medicine Horse team for a fun day of winter activities including equine, crafts, fun and play. Lunch, snacks and warm beverages will be provided. Please contact Medicine Horse to RSVP Winter Camps Arrival: 8am-9am Departure: 3pm-4pm Camp #1: February 20th and 21st 2016 Ages: 8-12 Camp #2: February 27th and 28th 2016 Ages: Camp #3: March 5th and 6th 2016 Ages: 8-12 Winter camps are one overnight at Medicine Horse in the medicine garden. Activities include; snaring, shelter building, fire safety and building, games and traditional teachings. See registration package for more information. Please submit winter camp registrations to Medicine Horse on or before February 18th Kids on the Land Days April 9 th and 24 th 10am-3pm

5 Children 0-12 and their families are welcome to come spend a day at the farm exploring the Forest Garden, learning about sustainable living, food production and some equine fun and games. Moms, Tots and Minis (DADS WELCOME TOO) April 9 th, 13 th and 20 th 10am-2pm (weather conditions permitting) Children aged 2-12 and their parents are welcome. Fun and games day with the miniature horses. Adult Day Camps June 21 st, 22 nd and 23 rd 10am-4pm Three days for adults over 18 including riding, instruction and safety, grooming, fun and games and team building.

6 Mistatim Medicine Horse Society 1429 Moonstone Rd Midland, ON MMHS REGISTRATION FORM PARTICIPANT CONTACT INFORMATION: (Please Print) NAME: BIRTHDATE: (MM/DD/YY) ADDRESS: SEX: (Please Circle) MALE/ FEMALE CITY: POSTAL CODE: TELEPHONE: ( ) PHOTO RELEASE CONSENT : PLS CIRCLE: YES / NO DO YOU SMOKE?: (Pls indicate here) HEALTH CARD NUMBER: CELL PHONE: ( ) SHOE SIZE: HOW DO YOU IDENTIFY: STATUS ( ) NON-STATUS ( ) METIS ( ) INUIT ( ) OTHER ( ) FIRST NATION: IF YOU CHECKED OTHER PLEASE INDICATE: PRIMARY EMERGENCY CONTACT INFORMATION: NAME: ADDRESS: RELATIONSHIP: CITY: DAY TELEPHONE: ( ) EVENING TELEPHONE: ( ) PARTICIPANT SIGNATURE: PARENT SIGNATURE: DATE: DATE: REFERRALS - THIRD PARTY AGENCY INFORMATION REQUIRED HERE: REFERRED BY: TELEPHONE: REASON FOR REFERRAL: AGENCY: ADDRESS:

7 Mistatim Medicine Horse Society 1429 Moonstone Rd Midland, ON Medical Information Release Participant Full Name: Physician: Phone: ( ) Address: Emergency Contact Name & Phone: Date of Birth: / / Month Date Year Physical Condition: (includes communicable diseases, diabetes, heart problems, etc.) Allergies: Reaction Symptoms: Recommended Emergency Treatment: Psychological Condition: (Medication if applicable) Medications: Reasons for Medication: Presenting Issues: (Physical, Mental, Emotional, Spiritual)

8 Does the participant have a physical disability? If yes, please describe: Special diet indicated? Do you have any special instructions for the staff regarding the participants physical and/or mental health to ensure the staff may provide the best care possible for your child: _ Have you ever participated in a sweat lodge ceremony before? If yes, where was it conducted? If no, is participant medically clear to participate in the Sweat Lodge? I (participant) consent to have information shared with the MMHS partnering agency; Enaahtig Healing Lodge and Learning Centre. What type of services are you seeking for your child? (Please circle all that apply) Coaching/Life Skills Traditional Teachings Horsemanship skills Peer Development Social Development Horseback riding skills Leadership skills Conflict Resolution Natural Medicines/ Walks Land based activities Gardening/ Nutrition Farming/ Organic Food Other: Parent Signature: Date: / / Participant Signature: Date: / / Month Date Year