Thank you for your interest in participating in the Skookum Jim Friendship Centre Grief Camp.
This land-based program is designed to provide Yukon First Nations youth with a culturally safe space to explore grief, healing, connection, and wellness through traditional teachings, time on the land, and community support.

Please complete all sections of this form. Information collected will be kept confidential and used only for program administration, participant safety, funding reporting requirements, and evaluation.

I understand that this is a culturally based wellness program and is not a clinical counselling service.

I understand that participation is voluntary and that I may choose not to participate in any activity if I am uncomfortable.

I agree to treat fellow participants, Elders, staff, volunteers, and the land with respect.

I understand that the Skookum Jim Friendship Centre will make every reasonable effort to provide a safe environment throughout the program.

I acknowledge that participants may share personal stories and experiences during this Grief Camp. I agree to respect the privacy and confidentiality of others by not sharing, discussing, or repeating another participant’s personal information, stories, or experiences outside of the camp without their express permission. I understand that maintaining confidentiality helps create a safe, respectful, and trusting environment for everyone involved.

I acknowledge that participation in this land-based Grief Camp involves inherent risks associated with outdoor activities and natural environments. I agree to follow all safety instructions provided by staff, Elders, and facilitators, to notify staff of any illness, injury, or safety concern, and to participate responsibly. I understand that Skookum Jim Friendship Centre will take reasonable measures to provide a safe environment and, in the event of a medical emergency, I authorize staff to seek emergency medical treatment on my behalf if I am unable to provide consent.

I certify that the information provided on this form is accurate and complete to the best of my knowledge.