Hosted by the Washoe Tribal Healing Center
Space is limited, first 30 applicants will be accepted.
Registrants age 12 to 17.

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1. By signing my name below, I acknowledge that I am the parent or guardian of the following attendee and give my permission for them to attend.

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2. By signing my name below, I understand that I cannot attend the Youth Tribal Opioid Summit, but can register for the Adult Tribal Opioid Summit, which is at the same location.

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3. Youth Name (First, Last)

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4. Youth Phone Number

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5. Youth Email

EMERGENCY CONTACT INFORMATION

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6. Guardian Name (First, Last)

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7. Guardian Phone Number

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8. Guardian Email

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9. Are you a Tribal member or descendant?

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