Youth Information

May Gun Lake Tribe contact youth by email?
Y/N Yes No

Youth can use technology (apps) for communications through email and phone?
Y/N Yes No

Emergency Contact 1 (Parent or Guardian)

May Gun Lake Tribe contact by email?
Y/N Yes No

Can use technology (apps) for communications through email and phone?
Y/N Yes No

I give the right to take photographs of my children in connection with Gun Lake Youth. I authorize the Gun Lake Tribe to use and publish photos from event(s) both in print and/or electronically.

Y/N Yes No

Parent/Guardian Electronic Signature:

Emergency Contact 2

May Gun Lake Tribe contact by email?
Y/N Yes No

Can use technology (apps) for communications through email and phone?
Y/N Yes No

ALL YOUTH PARTICIPANTS

BEHAVIOR EXPECTATIONS
As the Gun Lake Tribe Youth Program, it is our mission to promote the development of future Tribal leaders, provide a representative voice for Native youth and promote the Pottawatomi culture, language, pride and identity. The youth participant agrees to the following:

• All participants are expected to exhibit the seven grandfather teachings: Love, Respect, Humility, Wisdom, Bravery, Truth and Honesty, for themselves, other participants, staff, properties and facilities in which the Gun Lake Tribe Youth program is being held.
• Personal belongings are the sole responsibility of the youth.
• Refrain from the possession and use of weapons, tobacco products (unless for ceremonial or traditional purposes), vapes, alcoholic beverages and illicit drugs.
• Inappropriate physical contact with other participants is prohibited.
• Any behavior that violates any laws of the United States or the Gun Lake Tribe or any local ordinance is prohibited.
• Dress appropriately and according to the customs and standards of the venue that they are visiting.
• Electronic devices are to be used respectfully and appropriately. This means cellular phones should be on vibrate mode if they must be on to avoid disturbing others or disrupting an activity.
• Remain with their assigned groups at all times unless given permission from staff to do otherwise.

These expectations are in effect throughout the entire trip or activity.

These expectations are in effect throughout the entire of the trip or activity.

Challenging behaviors are often related to stressful or traumatic events youth experience in the surrounding neighborhood, in the community, or in the home. Before taking disciplinary action, Education staff will consider restorative measures, resources, and interventions that address the needs of the student. This may mean working with a youth to make right what was wronged, referring youth to other services, working with the youth and family to develop a behavior support plan, and other trauma-informed interventions. If interventions prove to be unsuccessful, this could result in disciplinary action and may include the following: suspension from free-time activities, confiscation of electronic devices (cell phones, tablets, etc.) until youth is picked up by parent/guardian, prohibition from participation in activities and/or being sent home. In the event that it is determined that any participant has violated the Behavior Expectations, the participant’s parent/guardian will be notified. The responsibility for making this determination is vested in the Youth Specialist and/or Education Director.

By filling out this release, I acknowledge I have read the Behavior Expectations with my youth and we understand and agree to adhere to the Behavior Expectations.

I have discussed the Behavior Expectations with and they are fully aware of and agree to the expectations to participate in Gun Lake Tribe Unity Council events.

LIABILITY RELEASE GENERAL

	Confirm that my child has basic swimming skills and has my permission to swim at places that may not have a certified lifeguard on duty.
	Give the right to take photographs of my children in connection with the identified event and future events put on by the Gun Lake Tribe Unity Council. I authorize the Gun Lake Tribe to use and publish photos from this event both in print and/or electronically.
	Give permission to the Youth Specialist and other qualified Gun Lake Tribe Staff to transport my child to and from events facilitated by the Gun Lake Tribe Unity Council.
	Understand that my child is to maintain proper usage of their electronics in a respectful and considerate way. If the presence of an electronic device becomes a distraction and inhibits my child’s participation, I understand the device will be confiscated and brought to the Youth Specialist to be returned to parents at pick up.
	Understand that if my child (or children) misbehaves and does not respond in a positive manner, I may be called to pick him/ her up. Warning will be given, but if inappropriate behavior continues, you will be contacted to pick up your child.
	Understand that my child is not to have any weapons on Gun Lake Tribal property or location of the event unless the item is approved for us by the Education Department or qualified chaperone(s).
	Understand that my child may participate in any number of activities in which there is a certain risk of physical injury involved with such activities, some of which I may presently be unaware of.
	Understand by signing this release form I am assuming such risks that are both known and unknown to me at this time. I further release the Gun Lake Tribe, its trustees, employees, facilities, and agents from any claim that I may have against them because of physical injury or illness during my child’s participation in the proceeding activities. This release of liability is also intended to cover all claims that members of my family, estate or heirs, representatives or assign may present against the Gun Lake Tribe, employees, rental facilities, including its trustees, employees, and agents.
	Understand by signing this release form I am assuming such risks that are both known and unknown to me at this time. I further release the Gun Lake Tribe, its trustees, employees, facilities, and agents from any claim that I may have against them because of physical injury or illness during my child’s participation in the proceeding activities. This release of liability is also intended to cover all claims that members of my family, estate or heirs, representatives or assign may present against the Gun Lake Tribe, employees, rental facilities, including its trustees, employees, and agents.

We may administer your non-prescription medicine (i.e. Tylenol, Benadryl, Motrin, Pepto Bismo, sunscreen, bug repellent etc.) and give routine non-surgical medical care to your child if deemed advisable by GLT Staff?
Y/N Yes No

PERMISSIONS CHECKLIST

Below are the functions/activities that may be offered by the Gun Lake Tribe Youth Program. Review the list and indicate in the box provided “Yes” or “No” that you give your permission for your child to participate.

YES	NO	Functions / Activities and Description
		Photographs/video/media of my youth in connection with Gun Lake Tribe Youth Program: I authorize the Gun Lake Tribe to use and publish photos from this event both in print and/or electronically for promotion and cultural publications.
		Cooking (using sharp utensils such as knifes, using high temperature cookware).
		Learning how to make a fire as part of cultural teaching.
		Participate in cultural teachings and practices such as ceremonies and cultural arts.
		Participate in archery or atlatl.
		Swimming in areas that may not have an active lifeguard on duty
		Collecting and using traditional plant medicines (smudging, ingesting teas, using plant salves).
		Water activities (canoeing, paddle boarding, diving, water polo, water slides).
		Transport in a tribally owned or leased vehicle to and from events facilitated by the Gun Lake Tribe.
		Water sports, obstacle course activities, traditional camp activities that may involve knife or fire use, cultural activities and teachings and other games/activities.
		Participate in physical contact sports (lacrosse, double ball, basketball)
		Other: (Please use this space to identify additional activities your child may or may not participate in)

I give permission for to attend and participate in Gun Lake Tribe Unity Council events.

Any infraction of the Code shall result in a meeting with the youth, parent(s)/ guardian, and Youth Specialist or Education Director.

MEDICAL WAIVER & RELEASE OF LIABILITY

PLEASE INITIAL AND SIGN

	I understand that this Waiver and Release of Liability is intended to be as broad and inclusive as permitted by Michigan law and agree that if any portion is held invalid that the remainder of the Waiver and Release of Liability will continue in full force and legal effect. I understand that the Gun Lake Tribe retains full sovereign immunity from suit, and that the Gun Lake Tribe neither makes nor intends any waiver of tribal sovereign immunity, whether by this Waiver and Release of Liability or otherwise.
	Understand if my child fails to show up on the day of travel, or cancels the trip for reasons not approved (other than documented emergencies such as medical emergencies or death in family), I must reimburse the Tribe all costs incurred. Any intent to cancel and/or withdraw from a trip must be communicated to the department in writing at least seven working days prior to departure.
	Understand that my child’s involvement in the Gun Lake Tribe Unity Council is a privilege. In consideration of this privilege, I am signing this release/consent form.

Health History for travel / overnight events

Health insurance information

Food Allergies/Type of Reaction:

Drug Allergies/Type of Reaction:

Insect Bite or Sting Allergies/Type of Reaction:

Other Conditions (Medical, Physical, Behavioral, Psychiatric or Social/Emotional Conditions):

List any current medications being taken, doses and frequency: All medication(s) [prescriptions and over the counter, if over the counter is provided] presently being taken, must not be expired, must be in their original packaging, be clearly marked with child’s name and complete dosage instructions. Only medications sent in original containers will be dispensed. Health Officer will dispense all medications.

Name of medication	Dosage	How taken/given	Medication Schedule	Reason for giving

May we administer your child’s prescription medicine, non-prescription medicine (i.e. Tylenol, Benadryl, Motrin, Pepto Bismo, sunscreen, bug repellent etc.) and give routine non-surgical medical care to your child if deemed advisable by GLT Staff?
Y/N Yes No


I, hereby authorize official meeting staff to secure whatever treatment is deemed necessary and, if recommended by an attending physician, the administration of an anesthetic or surgery.