Chilliwack YBYG 2024 Consent Form

YoBro | YoGirl Youth Initiative – Chilliwack School District Program 2024

AD Rundle Middle School 45660 Hocking Ave Chilliwack BC V2P 1B3 Tues 2:30–4:30 pm Brent Pinckney, VP

Location:  Multi-Purpose Room

In collaboration with the Chilliwack School District, Yo Bro | Yo Girl Youth Initiative (YBYG) is providing an extra-curricular program during the school day for youth. Information about YBYG can be found online at YBYG provides a pro-social recreational based program to enable youth to make healthy choices, develop personal competencies, and strengthen their commitment to their education and community. Additionally, the program offers community connectedness, mentorship, and role modeling opportunities.

Participation in the 2023-2024 YBYG after-school program at AD Rundle will include various sport activities and an introduction to self-defence techniques and martial arts. Serious issues such as drugs, alcohol and gangs will also be discussed. This is an exciting opportunity for youth to connect with peers, participate in some physical activity and confidence building activities, and to develop leadership skills.

YBYG Staff will run the program in partnership with the school while following BC Ministry of Health guidelines. Snacks will be provided for students at each session. If students have any food allergies or restrictions, or medical concerns, please indicate them in this consent page.

YBYG may wish to promote your child’s positive interactions, accomplishments, photographs, and video on its media, including the YBYG website, emails, social media, and printed or digital promotional materials, and will reach out for parental consent for publications that can be seen by the general public.

The program will take place on Tuesdays from 2:30-4:30pm starting on Tuesday Feb 6, 2024. If you have any questions, please contact Brent Pinckney ( or Joe Calendino (778.828.2799).

Students who are ill should not attend the program. Please do send not your child if they have any symptoms related to any respiratory diseases (such as the common cold, allergies or covid-19). If they become ill or experience any of these symptoms while at the YBYG Program your child will not be able to participate. Parents should provide contact information and be available to pick up their child immediately should their child become ill during the day.  

The consent package must be completed and submitted to the front office at the school, or emailed to the contact person listed at the top of the page, before your child can participate in the program. 


Accidents can result when youth participate in activities and can occur with or without any fault on either the part of the participant, School or its employees or agents, or the facility where the activity is taking place.  By allowing my child (the Youth) to participate in the Yo Bro | Yo Girl Youth Initiative (YBYG) Program (Program), I, the Parent/Guardian (s) am (are) accepting the risk of an accident occurring, and agree that the Program, is suitable for my child.

By signing the Consent, I, the PARENT/GUARDIAN confirm that I:

  1. have read and agree that the Program and activities are appropriate for the Youth and hereby provide consent for the Youth to participate in the activities;
  2. have represented to YBYG that the Youth is medically fit to participate in the Program and related activities, and have informed the Youth not to participate further if he/she/they feel anything to be unsafe;
  3. hereby agree that the Youth will not attend the Program or related activities if he/she/they is ill, including, but not limited to, symptoms associated with any respiratory disease (e.g., the common cold, allergies or COVID-19);
  4. hereby give my permission for the Youth to consume drink and food items provided during the Program and related activities;
  5. agree that I shall pay any and all financial obligations, loss or claims for compensation that YBYG or Chilliwack School District may suffer or incur in any way as a result of the Youth’s participation in the Program and related activities;
  6. hereby waive any and all legal rights that I may have now or in the future and release from liability and agree not to sue YBYG or Chilliwack School District for any loss or damage that I may suffer as a result of the Youth’s participation in the Program and related activities;
  7. hereby recognize that releasing YBYG from liability prevents me from claiming for money from YBYG or Chilliwack School District;
  8. have discussed with the Youth my expectations, YBYG’s expectations, and the risks and consequences if he/she/they does (do) not follow guidelines stated by the YBYG staff, and that I accept and assume all these risks and the consequences and freely choose to permit the Youth to participate in the Program and related activities regardless;
  9. hereby agree that it is my responsibility to arrange insurance to cover any loss or damage the Youth may suffer, or liability that may incur, as a result of the Youth’s participation in the Program and related activities;
  10. understand it is my right to obtain as much information as required about the Program and activities and associated risks and hazards, including information beyond that provided to by the school or program;
  11. recognize that YBYG may wish to use participants’ photographs that demonstrate positive interactions, accomplishments or achievements on it’s website or on promotional materials.
  1. acknowledge that YBYG and Chilliwack School District consents and written communication will be stored and shared between YBYG and Chilliwack School District in an online repository. Once participants such as my child are in the Program, communications will be conducted via phone, other online platforms or in person;
  2. acknowledge that YBYG preserves confidentiality of youth and families except when required by law, continuity of care, or the child’s and family’s safety.
  3. hereby agree that my child can be transported in a personal vehicle of a YBYG Outreach worker, and take part in skill building events or work with YBYG mentor. This means that my child may be exposed to certain risks and dangers while participating in, or being transported to events, and that I am aware that social distancing may not be enforced.