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Pomona's Cultural Tolerance Summer Camp July 16-20, 2012 Information & Registration Forms

Pomona's Cultural Tolerance Summer Camp July 16-20, 2012 Information & Registration Forms

Pomona's Cultural Tolerance Summer Camp

July 16-20, 2012

For Youth 14-18 Years

Registration Form will soon be available

For information or questions call or write to:

Linda D. Wright-Lee at 909-223-8535

or to Rev. Jan Chase at 909-596-4187 or 909-896-0991

Los Angeles County is on of the most culturally and religiously diverse places in the entire world. Yet conflicts locally and globally often begin because diversity is not respected or understood as a gift that widens our view of the world and opens the world to us in new ways.

The Pomona Valley Children and Family Collaborative and the Department of Children and Family Services have joined with other community partners to create an opportunity for youth 14-18 from all walks of life to come together to build bridges of understanding and respect while gaining tools for life from the five venues which are hosting this week long event.

This is a new and unique event hosted by the following Faith and Community Partners who will creatively through games and interaction find ways that youth can get to know themselves better, gain skills that foster a successful lifestyle and healthy relationships, and find ways to envision a community of love and peace through service.

Monday July 16: At Unity of Pomona, 254 E. Pasadena, Pomona 91767

Dr. Alane Daugherty of Cal Poly Pomona will present on the Intelligence of our Heart and ways to access that wisdom. She will incorporate science, stories, pictures, skits, attitude breathing, reflection and emotional balance techniques.

Tuesday July 17: At the Islamic Center of Claremont Community School,  3641 North Garey Ave. Pomona, CA 91767.

Principal Shabana Syed and past principal Ishmael Sam Tharpe. They will be presenting on the topic of Compassion, Service and Self Discipline, all aspects of fasting during the upcoming Holy month of Ramadan.

Wednesday July 18: South Hills Presbyterian Church, 1170 Fremont Pomona, CA 91766

Linda D. Wright-Lee will present of the topic Independent Living Skills and Is Your Budget a Secret. When living is so unbearable now, how will you survive on your own. What is the cost of
living ? You will choose and determine the cost on your own.

Thursday July 19: The African American Museum of Beginnings, 1460 E. Holt Ave. Pomona, CA 91766 The Village @ Indian Hill Entrance #3 Khalif Rasshan, curator.

The young people will have the opportunity to receive a historic view of African American culture from their pilgrimage between the shores of the African Continent and the progress to date. A permanent exhibit reflection African and African American history, life and civilization. A commemoration illustrating the life and achievements of modern and classic Africa.

The second presentation is Dr. Marian Safaouri, MD who will discuss:

    1. How she became a surgeon and the challenges that she faced.

    2). How to find hope when you feel that none exists and no one cares.

    3). Learning how to change a negative behavior, situation or thought into a positive one.

     4). The importance of staying in school and getting an education.

    5). The importance of positive affirmations and

    6). How to make realistic short-term and long term goals.

Friday July 20: Temple Beth Israel, 3033 N. Towne Ave. Pomona, CA 91767

Cantor Paul Buch and Youth Education Director Lea Zimmerman will present on the pillars of Tzedakah:

    1. Spiritual connection with higher power in the universe;

    2. Righteous action; helping build a just and fair world;

    3. Personal acts of loving kindness; building connections between individuals. This includes storytelling and communication skills.

Please spread the word about this life affirming, bridge-building event for our youth.

 Cultural Tolerance Summer Camp Registration Form

NAME _____________________________________ Likes to be called __________________

Sex _____ Age ____ Grade _____ (Participants must be 14-18 years old.)

Address: ___________________________________________________________________________

City _________________________________________________ State ______ Zip: _______________

Student’s phone #1*: (____)_______________home/cell Phone #2: (____)________________home/cell

Caregiver Name: ________________________________________________________________

Caregiver’s Phone: (____)________________home/cell (____)________________home/cell

Other Emergency Contact(s): _________________________ Emergency Phone: _________________

E-mail: (Youth) __________________________ (Caregiver) ____________________________

Sponsoring Agency, School or Faith Center: ______________________________________________

Responsible Coordinator: _______________________________ Phone: __________________



I certify that the above-named participant is in good health and able to participate in all activities:

___YES, ____NO If NO, specify limits of participation: _____________________________________¬

Allergic to any foods? ____YES, ___NO If YES, specify: _____________________________

Is participant currently under a doctor’s supervision for:

___ Epilepsy ___Diabetes ___Asthma ___Allergies (Not listed)________________________

Other condition or special-care needs (specify) _________________________________________________

As the above-named participant (or caregiver if participant is under age 18), I confirm that I am participating in this event of my own free will and have the appropriate permission to participate in and travel to/from this Youth Event. I knowingly and voluntarily assume all risks and dangers inherent and incidental to this event. I confirm that personal and medical information submitted here is current. Should you accept me (my child) as a participant, that I agree to all terms outlined in this Registration document, including holding harmless the group leaders, volunteers or any other representatives of the Faith Groups, DCFS, Los Angeles County, the Pomona Valley Children and Family Collaborative, or anyone distributing information about this event from all liability arising from participation in or attendance at this function. I shall hold harmless the COUNTY, its Special Districts, elected and appointed officers, employees and agents from and against any and all liability, including, but not limited to, demands, claims, actions, fees, costs and expenses (including attorney and expert witness fees), arising from or connected with this Youth Event.

I have read and agree to uphold all applicable Cultural Tolerance Summer Camp Agreements (youth).
and to arrange/pay for immediate transportation home if needed due to behavior or other situations.


X___________________________________________________ ___________
Signature of Participant (participant must sign!) Date
X_______________________ _____________________________ ___________
Signature of Caregiver (Print name Relationship) Date

Cultural Tolerance Summer Camp Agreements

By choosing to attend this event, I agree to do my part to help create a fulfilling experience for all.
I understand my choices not only affect my own experience, but others’ in the group as well.
My commitment is to support an environment that creates opportunities for self-discovery, and maintains physical & emotional safety for all.

I understand that certain behaviors which may be appropriate elsewhere are not appropriate during this event. In addition to applicable laws, I willingly agree to:

1. Respect all present.

2. Look for the highest good in all people and situations.

3. Be open to, and fully present for, the experience.

4. If I have difficulty focusing during any activity, I agree not to disrupt the experience of others.

5. Restrict use of cell phones, Ipods/MP3 players and other personal electronic equipment to break time.

6. Create a safe space for authentic sharing and reflection about one’s experiences.

7. Maintain a positive intention in all of my personal relationships.

I understand my willingness and ability to uphold these agreements are required to participate in this event. If I choose not to uphold them during an event, I understand my participation at this event may need to be restricted, and that I can be sent home early or dropped from further participation at this event.

Youth’s signature on Registration Form indicates willingness
to follow these Agreements. (Rev. 6/20/12)

Agreements start once you begin to travel to the event and end when
you have returned home.

Photography release. I hereby grant those in charge of this event permission to use photographs and videotapes in which the participant appears for publication, display, and advertizing, etc. purposes.

Yes _____

No ______


X___________________________________________________ ___________
Signature of Participant (participant must sign!) Date
X_______________________ _____________________________ ___________
Signature of Caregiver (Print name and Relationship) Date




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