NY’EHE Application

Native Youth Exploring Higher Education (NY'EHE)

Thank you for your interest in participating in the Native Youth Exploring Higher Education (NY'EHE) summer camp through WSU Native American Programs. If you have questions about this application please contact Joelle Edwards, joelle.edwards@wsu.edu.

Native American Programs will be hosting NY'EHE June 26-30, 2023. This camp is intended for incoming high school students. This camp will be held on the WSU Pullman campus. Students will be staying in residence halls.

There will be a variety of STEAM and college exploration activities throughout the week. Each day will be filled with academic, social, and light physical activities. 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 Pullman 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 1, 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*

Medications:
Medication is any substance a person takes to maintain and/or improve their health. This includes all prescription medication, as well as all over-the counter drugs that are potentially hazardous if misused (e.g., Tylenol, aspirin, cough medicine, cold tablets, vitamins & natural remedies. All medications must be in their original containers. Prescriptions must have the child’s name and how the medication should be given printed on the prescription container. Please send only those medications that are necessary. Participants are required to turn medications in to staff upon arrival.

Daily medications

Participant will not take any daily medications

Participant will be self-administering medication(s)

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

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