Youth Night

Youth Night is an inclusive drop-in space open to youth ages 9 – 13 years old. Join us for action-packed evenings hosted with various organized sports and activities. Don’t miss the fun!

Youth Night is offered every other week for the community on Tuesday evenings from 6:30 – 8:30 pm at the Pilot Butte School Gymnasium from Fall to Spring. Its a perfect place to make friends, get creative, and have fun!

Youth Night is back in November!

When:
Tuesday November 25 - "Recess Night" - dodgeball, four square & kickball

Time:
6:30 pm - 8:30 pm

Where:
Pilot Butte School Gymnasium

Cost:
This is a FREE drop-in program! No registration required.

Participants MUST complete a Participant Information Form, Waiver, and Image Release for their first day of attending the program. Simply bring it with you when you attend for the first time or complete online for below prior to.

For more information, or if you have questions, please contact the, Recreation Program Coordinator, by phone at 306-781-6253 or by e-mail at programs@pilotbutte.ca

Youth Drop-In Participation Form

PARTICIPANT INFORMATION

Participant Contact Name *

Physical Address *

Age *

Date of Birth *

Important Information ie; allergies, medications, disability, pronouns, etc:

EMERGENCY CONTACT INFORMATION

Emergency Contact Name *

Emergency Contact 1 - Phone Number *

Emergency Contact 1 - Relationship *

Alternative Emergency Contact Name

in case we can't reach you

Emergency Contact 2 - Phone Number

Emergency Contact 2 - Relationship

AFTER PROGRAM INSTRUCTIONS

After Program Instructions * Participant can go home alone
Participant will be picked up
Other arrangements. Please list below

Other arrangements

It is the parent/guardian's responsibility to educate their children as to whether or not they can leave on their own.

WAIVERS

Waiver of Liability

I agree to release, indemnify and save harmless the Town of Pilot Butte, and its elected officials, officers, employees, agents, representatives, volunteers, and other participants from and against all claims, proceedings and/or actions in respect of any costs, losses, damage or injury arising by reason of my or the dependent registrants’ participation in any activities offered by the Town of Pilot Butte, or by reason of the provision of medical care by the Town to me or the dependent registrants.

Waiver of Liability Agreement * I agree

Town of Pilot Butte Image Release

I hereby grant permission for my child to be photographed during the program for memorabilia and/or promotional material. I further acknowledge that the Town of Pilot Butte are the owners of all publication materials, and that photos may be used in any exhibitions, public displays, publications, commercial art, and advertising purposes including television without limit or reservation.

Town of Pilot Butte Image Release Agreement * I agree
I do not agree to these terms and do not consent to having my child's photo taken

* - denotes required field