2021-22 NYO Practice & Event Registration - Middle School
Please contact Coach Kyle Worl with any questions:

kworl@ccthita-nsn.gov or (907)227-4998

Start Date:
DHMS - Oct. 10
FDMS - Nov. 7

End Date:
Saturday, Nov. 19 (NYO Kick-Off event at UAS Rec. Center)

Practice Times:
Mondays & Tuesday from 3:05 PM - 4:25 PM

Location:
Floyd Dryden Middle School - Commons
Dzántik'i Héeni Middle School - Commons

Sign in to Google to save your progress. Learn more
Student Name: *
Student Preferred Name: 
Date of Birth: *
Student Email:
Student Cell:
Grade Level:
Clear selection
School: *
Is your child Alaska Native or Native American?
Clear selection
2022 Fall NYO Schedule 
I plan to attend practices at the following locations: *
Required
Transportation home:
Register me for the UAS Traditional Games Season Kick-Off, Saturday Nov. 19.   *
Captionless Image
Guardian Name: *
Guardian Email: *
Guardian Phone:
MEDICAL INFORMATION: Does your child have dietary restrictions, chronic illness (diabetes, epilepsy, asthma, etc.), injuries (dislocations, sprains, etc.), or any physical conditions that might limit or prevent your child from participating in certain activities. Additionally describe special accommodations which may be necessary to support your child.
AGREEMENT AND CONSENT FOR TREATMENT: This is to certify that I, the undersigned guardian, hereby consent to and authorize the administration of all needed medicines, performance of needed surgical treatment, and the administration of any anesthetic which is necessary in the opinion of the attending physician, and advisable in the event of medical emergencies regarding my son, daughter or dependent. It is understood that efforts shall be made to contact the undersigned prior to rendering emergency treatment to the patient. By typing my name below, I represent that I have knowingly and voluntarily signed this agreement:
AGREEMENT TO RELEASE ALL CLAIMS FOR INJURY OR DEATH TO MY CHILD/DEPENDENT AND TO PROTECT THE CENTRAL COUNCIL TLINGIT & HAIDA & JUNEAU SCHOOL DISTRICT AND OTHERS FROM ANY SUCH CLAIMS WHICH MAY BE BROUGHT I, parent/guardian of the student named within this form give my permission for him/her to participate in the Native Youth Olympics practices, and associated events. I have made this choice in recognition and appreciation that there will be known and unknown risks, dangers and hazards which could cause personal injury (up to and including death; collectively, “Personal Injury”) to my child/dependent which may be encountered during the program. With this in mind, in return for my child/dependent’s participation, I DO HEREBY VOLUNTARILY ASSUME ALL RISKS, DANGERS AND HAZARDS which my child/dependent may encounter during his/her participation in, and transportation to, from or as a part of, the Native Youth Olympics program. Further, in consideration of my child/dependent’s participation, I hereby release Central Council Tlingit & Haida and Juneau School District, and its Officers, Agents and Employees (released parties), from all liability and claims of any kind, including claims for loss, expense, damages, punitive damages or attorney fees, which may arise on account of Personal Injury to my child/dependent, including emotional distress to me. Further, I promise to indemnify and hold harmless the Central Council Tlingit & Haida and Juneau School District, and pay all costs of defense, if claims are brought by me or anyone else against any of the released parties to recover money damages related to any and all  I have entered into this agreement on the basis of my own information and not in reliance upon other released parties. I understand that I have the right to consult an attorney of my choice before signing. I further understand that this document contains the entire agreement and no oral or written agreements limiting or modifying the effect of the terms of the agreement exist. I agree that if any part of this agreement is held to be invalid or unenforceable for any reason, the balance of the agreement remains valid and enforceable. By typing my name below, I represent that I have knowingly and voluntarily signed this agreement: *
MEDIA RELEASE: We, the guardian and student, give permission for Central Council Tlingit & Haida to include our names and/or pictures/videos in news stories, and educational and cultural materials about events OF the Native Youth Olympics. By typing my name below, I represent that I have knowingly and voluntarily signed this agreement:
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Juneau School District. Report Abuse
Google Forms