Participant form to complete

NWTA May 2024

Form for collecting personal data from participants. IMPORTANT: Data will be destroyed after the AING.

Part 1 - Membership Agreement

I) PARTICIPANT identification

Participant name(Required)

Firstname Lastname

E-mail(Required)

Phone(Required)

Adress(Required)

Street Street City Province ZIP Country

Language

The Aventure Initiatique du Nouveau Guerrier (AING) will be offered primarily in French, but accommodations will be put in place to allow an English-speaking audience to fully experience

Primary language(Required)

My primary language is English

My primary language is French

My primary language is not French, but I understand it well enough to feel independent.

I don't understand enough French to feel autonomous.

II) Vocabulary

"MKP", "ManKind Project", "the community", "the center" refers to the MKP Quebec center.
"AING", "New Warrior Training adventure", "weekend", "training", refers to the training weekend given by MKP from May 17 to 19, 2024.
"The participant", "you" - indicates the person whose name appears in the "Name" section under I) Identification.

III) Fees

800 (or $750 - if you took advantage of early bird registration).
Payable in full no later than Friday upon arrival on site (unless otherwise agreed between the center and the participant).

Payment agreement

I need a payment agreement

By checking this box, the Participant Registrar will contact you if you require a payment arrangement.

IV) Commitment of the participant

The participant agrees to:

Pay the NWTA fee in full no later than the Friday of the event, at the NWTA registration table (unless otherwise agreed between the participant and the center) and respect the staggered payment agreement if such an agreement has been made.
Read the document sent by e-mail before the NWTA.
Complete this form within 7 calendar days of receiving it.
Do not consume alcohol or legal or illegal drugs, other than medication prescribed by a physician, in the 36 hours preceding the training. If you have consumed any of these substances within 36 hours, please notify staff upon arrival at the site.
Arrive between 5:30 p.m. and 6:00 p.m. on the Friday of the event at Domaine Scout St-Louis-de-France, 1295 chemin des Pins, Trois-Rivières, G8W 2K1 and attend the AING until 4:30 p.m. on Sunday.
Bring a prepared meal for 3 guests. See the Document included in the e-mail for details.
If you live less than 200km from the NWTA, attend the celebration from 1 to 4 p.m. on Sunday, June 9, near Trois-Rivières (location to be confirmed).
Cooperate with staff in overcoming any circumstances that would prevent compliance with this agreement.

V) Refund policy

If after the NWTA you are not satisfied with the training and wish to be reimbursed, your registration fee will be refunded (less the $200.00 registration deposit). To do so, you must have met each of the following conditions:

Registration fees have been paid in full prior to the weekend, and all agreements have been met prior to the weekend.
You have attended the entire NWTA and participated fully in all NWTA workshops.
You have requested a refund in writing, stating the reasons for your dissatisfaction within seven (7) calendar days of the NWTA.
You have met and discussed with the registrar. Your registrar is:

Robert Mercier / Phone : 514-246-8449 / Courriel : Robertmtl1969@gmail.com

I confirm that I understand and accept the above terms and conditions:

Name

Firstname Lastname

Signature(Required)

Part 2 - Participant's Acknowledgement of Inherent Risks and Full Personal Responsibility

The purpose of this part is to let you know what you are committing to, and to ask you to commit to taking personal responsibility for your own safety, the safety of others, and your well-being.

NWTA usually takes place in a youth camp, with facilities that are often basic and in remote locations. Some of the activities are very physical and may take place outdoors on challenging terrain where you'll be exposed to the elements. This is not a weekend to relax in a SPA. You'll have the opportunity to take a deep look at your life to see what's working, what's not, and what's causing certain reactions and the way you react to your relationships and your life. The work you'll be doing during the NWTA is physically, emotionally and psychologically challenging. It's not for everyone. None of the activities or processes of NWTA are mandatory. Every man is free to choose whether or not to participate in each of the processes or activities. It's up to you to determine for yourself whether you're ready for NWTA. However, we invite you to step out of your comfort zone and dare to discover your potential.

We are an inclusive and welcoming community. We've welcomed men from many different backgrounds and at many different stages of their lives to our NWTA. The men who participate in the NWTA can be young or quite old. Professional athletes as well as quadriplegic men can take part. We insist that you take care of yourself, know your limits and have the courage to refuse to participate in any activity or process that exposes you to risk beyond what you are prepared to accept.

Describe any physical problems you have that are likely to create problems for you or others:(Required)

List all the foods and medications to which you are allergic and any other allergies you have.(Required)

Indicate the impact of the allergy (e.g. gluten intolerant vs. celiac) to help us understand the severity.

Describe any mental health problems you may have that are likely to create problems for you or others:(Required)

No alcohol, legal or illegal drugs are allowed during the NWTA. Describe any addictions you have that could create problems for you or others:(Required)

Have you attempted suicide in the last 2 years?(Required)

Yes

Have you been hospitalized for mental illness in the past 2 years?(Required)

Yes

List the names of all the medications you are taking:(Required)

If you have any concerns about your ability to participate in the weekend, we recommend that you seek the opinion of one or more healthcare professionals involved in your care. We also ask that you describe your concerns in one of the spaces above, so that we are aware of your situation.

By signing this document, you acknowledge that there are risks associated with participating in an NWTA, that you voluntarily assume these risks, that you have sought the advice of your healthcare professional (if applicable), that you are committed to taking care of yourself during the NWTA weekend, and that you will take full responsibility for your own safety. You further certify that you have disclosed all physical, psychological and psychiatric conditions that may affect your participation in the NWTA.

Name(Required)

Firstname Lastname

Date Signature(Required)

Sign(Required)

Part 3 - Emergency contacts

We ask you to list the name and contact details of at least one person we can contact in the event of an emergency.

Emergency contacts

CONTACT 1 (Required):

CONTACT 2 (Optional):

First contact name(Required)

First name Lastname

Second contact name

Firstname Lastname

Contact adress 1(Required)

Address Address City Province / State ZIP Country

Contact adress 2

Address Address City Province / State ZIP Country

Contact 1 phone(Required)

Contact 2 phone

Email contact 1(Required)

Email contact 2

Part 4 - Confidentiality agreement

Participant's commitment to confidentiality

While participating in NEW WARRIOR TRAINING ADVENTURE (NWTA) program and activities, I will learn details of customs, protocols, traditions, exercises, rituals, processes and other information, in oral and written form, to which MKP has exclusive rights ("Proprietary Information").

In addition, I may learn during the course of the program information about other participants that is confidential ("Confidential Information").

As a condition of my participation in the Program: I agree that I will not reproduce, copy or otherwise disclose, in any form or manner, written or oral, any Proprietary Information without the express written permission of MKP. I further agree that I will not reveal in any form or manner, written or oral, any information about other participants that is confidential that I learn as a result of my participation in the program and its activities. I may, however, share my personal experience of the program and its activities if the confidentiality of proprietary and confidential participant information and any other confidential information is maintained.

MKP's commitment to confidentiality

MKP is committed to maintaining the confidentiality of information as described above. However, if the recent or ongoing actions of a participant in any MKP program appear to place him or her or any other person in physical, emotional or psychological danger, or if it appears that he or she may engage in such actions in the foreseeable future, MKP may be required by law to report such actions or information to an appropriate agency or organization. Even in the absence of an appropriate mandate, MKP may act to protect the participant or any other person from foreseeable harm or danger, while providing the participant with support and assistance.

Date(Required)

Sign(Required)

Part 5 - Confidential pre-AING questionnaire

The upcoming New Warrior Initiation is a chance for you to look at yourself as a man, to assess where you are and where you want to go in life. Before you learn what it's like to live as a warrior, and as a brother to other warriors and those you love, we ask you to complete this questionnaire. We want to know who you are and what you want from life.

The experience of adventure encourages you to take risks and trust. Please approach this questionnaire with this in mind. This questionnaire will remain strictly confidential and no copies will be made.

Instructions

Answer the following questions. Don't think too long about the questions. Write down your first spontaneous answer.

1. People can make me angry when ...(Required)

2. I would like ...(Required)

3. People drive me crazy when ...(Required)

4. I'm tired of ...(Required)

5. What bothers me most about my work/studies is ...(Required)

6. I don't think it's fair that I'm expected to ...(Required)

7. I wish people would stop telling me ...(Required)

8. As soon as possible, I will ...(Required)

9. The things that bother me most are ...(Required)

10. I'm sad when ...(Required)

11. I'm jealous when ...(Required)

12. I'm afraid when ...(Required)

13. If I could change anything, I would ...(Required)

14. Je suis frustré lorsque ...(Required)

15. I get annoyed when ...(Required)

16. One thing people never notice about me is ...(Required)

17. One thing that really makes me angry is ...(Required)

We all live in constant change and evolution. The experience of this "Adventure" is an opportunity for you to grow. Growing is the result of living life to its fullest.

What are the 3 greatest fears in your life?

Fear #1(Required)

Fear #2(Required)

Fear #3(Required)

What are the 3 goals that relate to your personal development as a man?

Objective #1(Required)

Objective #2(Required)

Objective #3(Required)

Identify 3 things you want to get rid of for good:

Liberation #1(Required)

Liberation #2(Required)

Liberation #3(Required)

General well-being index

My self-confidence level is how many out of 10?(Required)

Zero =Very low - Ten = Very high

What's my self-esteem level out of 10?(Required)

Zero =Very low - Ten = Very high

I trust others(Required)