*1.Participant's Information(Required.)

1st Participants
First Name:

Last Name:

Gender( Male, Female, Prefer not to Answer):

Age(12-18):

Grade Level:

School Attending :

2nd Participants
First Name:

Last Name:

Gender( Male, Female, Prefer not to Answer):

Age(12-18):

Grade Level:

School Attending :

3rd Participants
First Name

Last Name:

Gender( Male, Female, Prefer not to Answer):

Age(12-18):

Grade Level:

School Attending :

4th Participants
First Name

Last Name:

Gender( Male, Female, Prefer not to Answer):

Age(12-18):

Grade Level:

School Attending :

*2.Parent/ Guardian Name(Required.)

*3.Parent/ Guardian Email (So we can send confirmation & conference  information)(Required.)

*4.Parent/ Guardian Phone Number (So we can contact in case of emergency)(Required.)

5.What is your mailing address?

Street address:

City 

State

Zip

*6.Tribal Affiliation:(Required.)

Salt River Pima-Maricopa Indian Community (Member/ Resident) 

Other (please specify)

*7.

COMMITMENT TO PARTICIPATE

You can count on my full participation in all sessions and activities of the 2026 Native Youth Identity Conference. I pledge to conduct myself in a manner that will bring only credit to the Salt River Indian Community. I will treat all participants, presenters, chaperones, facilitators, and staff with respect. I pledge to wear my name badge around my neck and visible at all times. I pledge to remain drug, tobacco, and alcohol free during the entire conference.

Please type your signature (Participant).(Required.)

First Participant:

Second Participant:

Third Participant:

Fourth Participant:

*8.

MEDICAL AUTHORIZATION/ LIABILITY RELEASE

If the participant is a minor, this form must be signed by a parent or legal guardian. I hereby approve the participation of my son/daughter in the 2023 Native Youth Identity Conference. In the event of illness or accident, I give my consent for him/her to receive medical attention. Also, I will not hold liable the Salt River Pima-Maricopa Indian Community, or any of its agents, volunteers or other organizations involved in this conference. I will also be responsible for any damages to public or private property done by the above named minor during the entirety of above mentioned event.

Please type your signature (Parent / Guardian)(Required.)

Signature of Parent/ Guardian
if one or all participants 17 years or less.

First Participant if 18 years or more:

Second Participant if 18 years or more:

Third Participant if 18 years or more:

Fourth Participant if 18 years or more:

*9.

PHOTO RELEASE

By signature below I grant permission to photograph and/or film my child for use by the Salt River Pima-Maricopa Indian Community Youth Services or the media for the purpose of information the public of programs provided by the Salt River Pima-Maricopa Indian Community.

Please type your signature (Parent / Guardian)(Required.)

Signature of Parent/ Guardian
if one or all participants 17 years or less.

First Participant if 18 years or more:

Second Participant if 18 years or more:

Third Participant if 18 years or more:

Fourth Participant if 18 years or more: