NY’EHE Registration Everett Friday, June 16th - 10 a.m. - 6

Native Youth Exploring Higher Education (NY'EHE)

Thank you for your interest in participating in the Native Youth Exploring Higher Education (NY'EHE)- Everett 1-day camp through the WSU Office of Tribal Relations in collaboration with WSU Everett. If you have questions about this registration, please contact Sharon Mail Kanichy, tribal.relations@wsu.edu.

We will be hosting NY'EHE-Everett on Friday, June 16, 2023. This camp is intended for students who will be in High School in the Fall of 2023. This camp will be held on the WSU Everett campus and is a 1-day camp.

There will be a variety of STEAM and college exploration activities throughout the day. We will provide participants with all supplies needed for the camp. You will learn from WSU faculty, staff, and students and other cultural guests.

All expenses for this camp are provided free of charge except for transportation to and from the WSU Everett campus. Transportation is the participants' responsibility. This application must be completed by both the student and their parent(s)/guardian(s). Spots are limited, so apply early.

The application deadline is June 2, 2023.

Education Information

When will you graduate high school?*

Current School*

Cumulative GPA

Academic interest*

Family & Emergency Contact Information

Parent/Guardian First Name*

Parent/Guardian Last Name*

Parent/Guardian Email

Parent/Guardian Phone*

Relationship to Student*

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

Parent/Guardian 2 Email

Parent/Guardian 2 Phone Number

Relationship 2 To Student

Emergency Contact (other than parent)*

Emergency Contact Phone Number*

Contracts

Personal Respect Contract

Respect of self is the first aspect of giving respect to others. We are working to inspire the youth of the Native Youth Exploring Higher Education (NY'EHE) programs to develop a mature work ethic. We believe work ethic begins with showing respect to self and those that you work with. Behaviors that we would like to see exhibited are the following:

1. BEING ON TIME TO ALL ACTIVITIES: This is the most important. (An example of being disrespectful is being late for any of the scheduled activities that have been planned.)

2. When in workshops, show respect by being attentive and listening with interest. (An example of disrespect would be laying your head down on the desk and sleeping or passing notes to each other.)

3. No cell phones or electronics will be allowed during labs or other class activities.

4. Being respectful of fellow participants. This includes no put-downs, no rough horse play, and no foul language.

5. Following directions. WSU staff will be with participants throughout the day, ensuring participation and safety of all. Respectfully comply with instructions, so program will be enjoyable for everyone.

6. USE, POSSESSION, OR DISTRIBUTION OF WEAPONS, ALCOHOL, DRUGS, TOBACCO OR ANY OTHER ILLEGAL PRODUCT IS PROHIBITED. YOU WILL BE REPORTED TO LAW ENFORCEMENT AND BE SENT HOME IMMEDIATELY.

7. All participants are expected to be dressed appropriately.

Yes, I agree to the statement above

No, I do not agree to the statement above

Parent Authorizations:
Assumption of Risk
I understand that there are risks in participating in lab activities, classroom workshops at the Native Youth Exploring Higher Education (NY'EHE)activities at Washington State University (WSU).

In consideration for and as a condition of being allowed to participate in this voluntary activity, I agree to take full responsibility for any and all risks that exist, including the risk of death or injury to the participant or loss or damage to my property. I understand that there may be risks that WSU cannot predict or foresee, and I also assume full responsibility for those risks.

Risks in participating in the Native Youth Exploring Higher Education (NY'EHE) activities including lab activities, classroom workshops and recreational activities include, but are not limited to: temporary or permanent muscle soreness, sprains, strains, cuts, abrasions, bruises, ligament and/or cartilage damage, orthopedic damage, head, neck or spinal injuries, loss or use of arms and/or legs, eye damage, disfigurement, burns, drowning or death. I also recognize that there are both foreseeable and unforeseeable risks of injury or death that may occur as a result of traveling to or from the Native Youth Exploring Higher Education (NY'EHE)activities that cannot be specifically listed. Further, I recognize that the actions of other participants in the activity may cause harm or loss to the participant or my property. I also understand I may be exposed to various infectious pathogens known to cause illness and disease in humans, including, but not limited to SARS-CoV-2. I am aware SARS-CoV-2, which causes COVID-19, is circulating within the community, and within shared space settings. I voluntarily and freely agree to knowing the risks of contracting COVID-19 and other respiratory illnesses during this experience. Such risks include, but are not limited to, respiratory failure, organ failure, death, aggravation of existing health conditions, stress, social-stigmatization, and/or spreading the infection to others.

Release of Liability

I release the state of Washington, the Regents of WSU, WSU, any subdivision or unit of WSU, its officers, employees, and agents, from any and all liability, claims, costs, expenses, injuries and/or losses, that I may sustain as a result of my participation in the above event. My participation includes, but is not limited to, travel to and from the event in a private or public vehicle, and any activity connected with the event itself, and while using state equipment or facilities for the event whether on or off WSU property.

I have carefully read this document, understand its contents, and am fully informed about this program and its events and circumstances and being apprised of the risks inherent in the activity, assume the risk of participation and release WSU from liability as set forth here in. I am aware that this document is a contract with WSU. I, or my parents/legal guardians if I am under the age of eighteen, sign it freely and voluntarily.

Yes, I agree to the statements above

No, I do not agree to the statements above

Student: Please type your full legal name below as an electronic signature. By providing my electronic signature below, I certify that my responses are true and correct to the best of my knowledge.

Date of student's electronic signature

Parent/legal guardian: Please type your full legal name below as an electronic signature. By providing my electronic signature below, I certify that my responses are true and correct to the best of my knowledge.

Date of parent/legal guardian's electronic signature

In Case of Medical Emergency
In an emergency requiring medical attention or a situation reasonably believed to be an emergency by Washington State University (WSU) authorized agents including event staff; I authorize WSU and its authorized agents to obtain emergency medical care for my child. I will be responsible for any expenses incurred in so doing including but not limited to care by health care professionals, hospital care, and ambulance or other services. In addition, the health care provider has permission to obtain a copy of my child’s health record from providers who treat my child and these providers may talk with the program’s staff about my child’s health status.

NOTE: Minors may consent to certain services in Washington.

I hold harmless and agree to indemnify Washington State University, its authorized agents and employees and the event staff from decisions to seek emergency treatment.

Yes, I agree to the statement above

No, I do not agree to the statement above

Date of parent/legal guardian's electronic signature

Images and Recordings Consent
We hereby grant permission to Washington State University (WSU) to be photographed or otherwise have images or voice recordings made (including but not limited to digital photographs, video or digital moving images and/or voice recordings), for WSU publication or promotional purposes in any medium (including but not limited to print media, newspaper, television, video, motion picture, or Web site on the Internet).
I additionally consent to the use of the participant’s name and/or interview comments in connection with WSU publication or promotional purposes in print media, newspaper, television, video, motion picture, or Web site on the Internet.

We understand that consent to use the participant’s likeness or voice recordings is not a condition of participating in the activity and that consent can be refused without any impact in the ability to fully participate in the program.

No inducements or promises beyond our acceptance of an opportunity to promote WSU and its programs have been given to the persons signing below.

Any other use of images and/or recordings, my name, and/or interview comments requires advance permission.

We understand that we can revoke this consent at any time upon notice to WSU, at which time either or both of us will sign a copy of the denial (below) for use of images or voice recordings.

Yes, I agree to the statement above

No, I do not agree to the statement above

Date of electronic signature

University Recreation Assumption of Rock & Release of Liability
In consideration for being allowed to utilize University Recreation programs, services, facilities and equipment as well as traveling to or from any activity or program organized or affiliated with the University Recreation Department, either on or off any Washington State University properties, I voluntarily agree to assume all risks involved in participating in, traveling to or from, or using University Recreation programs, services, facilities and equipment. I understand that direct supervision by Washington State University staff may not be provided and by participating in, traveling to or from, or using the programs, services, facilities of University Recreation, I expose myself to the risk of injuries including but not limited to temporary or permanent muscle soreness, sprains, strains, cuts, abrasions, bruises, ligament and/or cartilage damage, head, neck or spinal injuries, loss of use of arms and/or legs, eye damage, emotional trauma, disfigurement, drowning or death. I also understand I may be exposed to various infectious pathogens known to cause illness and disease in humans, including, but not limited to SARS-CoV-2. I am aware SARS-CoV-2, which causes COVID-19, is circulating within the community, and within shared space settings. I voluntarily and freely agree to knowing the risks of contracting COVID-19 and other respiratory illnesses during this experience. Such risks include, but are not limited to, respiratory failure, organ failure, death, aggravation of existing health conditions, stress, socialstigmatization, and/or spreading the infection to others. I also recognize that there are both foreseeable and unforeseeable risks of injury or death that may occur as a result of my participation in, traveling to or from, or use of University Recreation programs, services, facilities, and equipment that cannot be specifically listed. I also recognize that the actions of other users of University Recreation programs, services, facilities, and equipment may cause harm or loss to my person or property and agree to assume the risks of same.

Release of Liability
I, my heirs and assigns hereby release the State of Washington, the Regents of Washington State University, Washington State University, the University Recreation Department, and the employees, agents or representatives of Washington State University (hereafter referred to as the UNIVERSITY GROUP) from any and all liability, claims, costs, expenses, injuries or losses including those resulting from acts of negligence by the UNIVERSITY GROUP that I may otherwise sustain as a result of my participation in, traveling to or from, or using University Recreation programs, services, facilities and equipment, or the administration of emergency first aid and/or medical aid. I also release the UNIVERSITY GROUP from loss or damage to my person or property caused by other users of University Recreation programs, services, facilities, and equipment. If any part or portion of this Assumption of Risk and Release of Liability is determined to be invalid or unenforceable, the remaining parts or portions shall be enforceable. This release and all matters related to your activities involving Washington State University shall be governed by and interpreted in accordance with Washington law. I have carefully read this Assumption of Risk and Release of Liability and fully understand its contents. I am aware that this Assumption of Risk and Release of Liability is a contract between the UNIVERSITY GROUP and myself and I sign it of my own free will.

Yes, I agree to the statement above

No, I do not agree to the statement above

Student: Please type your full legal name below as an electronic signature. By providing my electronic signature below, I certify that my responses are true and correct to the best of my knowledge.

Date of electronic signature

University Recreation Assumption of Rock & Release of Liability for participants under the age of 18
I understand that there are risks in participating in recreational activities and educational workshops in UNIVERSITY RECREATION facilities, services and programs at Washington State University (WSU). In consideration for and as a condition of being allowed to participate in this voluntary activity, I agree to take full responsibility for any and all risks that exist, including the risk of death or injury to my child or loss or damage to my property. I understand that there may be risks that WSU cannot predict or foresee, and I also assume full responsibility for those risks. Risks in participating in University Recreation programs, services or facilities (including participating in supervised or unsupervised activities in or connected with the Student Recreation Center, WSU playfields, Smith Gym, Gibb Pool, Physical Education Building, Hollingbery Fieldhouse, Chinook Student Center, and Down Under Recreation Center), include, but are not limited to: risk of injuries including but not limited to temporary or permanent muscle soreness, sprains, strains, cuts, abrasions, bruises, ligament and/or cartilage damage, bone fractures and/or breaks, head, neck or spinal injuries, loss of use of arms and/or legs, eye damage, burns, emotional trauma, drowning, disfigurement, or death. I also understand that my child may be exposed to various infectious pathogens known to cause illness and disease in humans, including, but not limited to SARS-CoV-2. I am aware SARS-CoV-2, which causes COVID-19, is circulating within the community, and within shared space settings. I voluntarily and freely agree to knowing the risks of contracting COVID-19 and other respiratory illnesses during this experience. Such risks include, but are not limited to, respiratory failure, organ failure, death, aggravation of existing health conditions, stress, social-stigmatization, and/or spreading the infection to others. I also recognize that there are both foreseeable and unforeseeable risks of injury or death that may occur as a result of traveling to or from University Recreation activities and facilities that cannot be specifically listed. Further, I recognize that the actions of other participants in the activity may cause harm or loss to my child or property.

RELEASE OF LIABILITY
I release, the state of Washington, the Regents of WSU, WSU, any subdivision or unit of WSU, its officers, employees, and agents, from any and all liability, claims, costs, expenses, injuries and/or losses to person or property, which I may sustain and/or sustain as a result of death or injury of my child, as a result of or connected with participation in the above event. My child’s participation includes, but is not limited to, travel to and from the event in a private or public vehicle, any activity connected with the event itself, use of state equipment or facilities for the event whether on or off WSU property, or the administration of emergency first aid and/or medical aid. I have carefully read this document, understand its contents and am fully informed about this program and circumstances. I am aware that this document is a contract with WSU and the program sponsors. I sign it freely and voluntarily.

Yes, I agree to the statement above

No, I do not agree to the statement above

Date of parent/legal guardian's electronic signature