2016 Native HOPE Registration

Allere Campo 2016 Information

October 5th-7th 2016, 9:00am to 5:00pm

Open to Guadalupe and surrounding area youth, tribal or non-tribal- 5th grade to 12th grade

Will be held at Itom Hiapsi

9405 S Avenida del Yaqui Guadalupe, 85283.

Breakfast and Lunch will be served

We have room for 60 youth first come first serve

For questions regarding the conference should be directed to:

Vanessa Bustos 480-768-2064 vanessa.bustos@pascuayaqui-nsn.gov or

Ricky Vital 480-768-2063 ricardo.vital@pascuayaqui-nsn.gov

The Guadalupe Prevention Partnership will not be responsible for lost or stolen items or held liable for any injury or other occurrence to participants while attending the Native HOPE events.

Question Title

* 1. Guardian Information:

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. Child Registration:

Child #1 Name:

Child #1 Grade:

Child #2 Name

Child #2 Grade

Child #3 Name

Child #3 Grade

Child #4 Name

Child #4 Grade

Child #5 Name

Child #5 Grade

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* 3. Emergency Contact:

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 4. Allergies:

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* 5. Transportation Release

I hereby give permission for the transportation of my child for official Leadership & Development activities by modes of transportation agreed to by the retreat organizers.

Parent’s/Guardian’s Initials ____________

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* 6. I understand that I will be notified in the case of a medical emergency involving my child. In the event that I cannot be reached, I authorize the calling of a doctor and the providing of necessary medical services in the event my child is injured or becomes ill.

Parent’s/Guardian’s Initials ____________

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* 7. I understand that the Pascua Yaqui Tribe will not be responsible for the medical expenses incurred, but that such expenses will be my responsibility as parent/guardian.

Parent’s/Guardian’s Initials ____________

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* 8. I hereby waive and release the Guadalupe Prevention Partnership and Lutu'uria Youth Group to photograph child(s) for use in Pascua Yaqui Prevention Program presentations & promotional materials. I acknowledge that the Guadalupe Prevention Partnership and Lutu'uria Youth Group will use the photographs at their discretion.

Yes

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* 1. Guardian Information:

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* 2. Child Registration:

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* 3. Emergency Contact:

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* 4. Allergies:

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* 5. Transportation Release I hereby give permission for the transportation of my child for official Leadership & Development activities by modes of transportation agreed to by the retreat organizers. Parent’s/Guardian’s Initials ____________

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* 7. I understand that the Pascua Yaqui Tribe will not be responsible for the medical expenses incurred, but that such expenses will be my responsibility as parent/guardian. Parent’s/Guardian’s Initials ____________

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* 9. Any comments for the Guadalupe Prevention Partnership Staff?

* 5. Transportation Release

I hereby give permission for the transportation of my child for official Leadership & Development activities by modes of transportation agreed to by the retreat organizers.

Parent’s/Guardian’s Initials ____________

* 7. I understand that the Pascua Yaqui Tribe will not be responsible for the medical expenses incurred, but that such expenses will be my responsibility as parent/guardian.

Parent’s/Guardian’s Initials ____________