CRITFC Salmon Campapplication

CRITFC Salmon CampApplication

COLUMBIA RIVER INTER-TRIBAL FISH COMMISSION / FORM CAMP
Submit application packet as soon as possible in order to secure a limited FREE slot. Time is needed to review applicants, make selections and notify those who are admitted into the program. It is strongly encouraged that you call to confirm that your application was received.
Camp conditions / SalmonCamp is a five-day/four-night camp. The weather will be hot and sunny during the day, and possibly chilly at night. It is strongly suggested that students leave all valuables at home (iPods, video games, money, jewelry, etc). CRITFC is not responsible for any lost, damaged or stolen property. CRITFC staff will have cell phone service.
Transportation / It is the responsibility of the parents or guardians of camp attendees to get their child to and from the designated check-in and pick-up locations. Details and locations will be provided to campers upon selection.
Instructions /

Fill out this application in full. It includes:
Application Form
Student Essay
Consent and Release Agreement
Student Agreement
This document is an electronic form. You can fill it out using Microsoft Word, but it must be printed to be signed.
If you do not have Microsoft Word and will be filling out this form physically, please print or type in black or blue ink.
If you have questions or need assistance filling out the application, please contact:
Tana Atchley
Salmon Camp Coordinator
(503) 238-0667
The deadline for submitting an application is 5:00 pm, Friday, May 26, 2017.

Salmon Camp 2017 Application

COLUMBIA RIVER INTER-TRIBAL FISH COMMISSION / FORM CAMP-APP
Student Information / First name and initial / Last Name
Date of birth / Gender
Female Male / Previous Salmon Camp attendee?
No Yes (Year )
Grade in Fall 2017 School Year
6th grade 7th grade 8th grade / Tribal Affiliation
Yakama Umatilla Warm Springs Nez Perce
Parent/Guardian
Mailing Address / City / State / ZIP
Primary Phone / Primary Phone
Email
Emergency Contact and Medical Information / List two emergency contacts (adults) and their contact information.
1 / Name / Home Phone / Other Phone
2 / Name / Home Phone / Other Phone
Student’s Primary Care Physician
Provider’s Clinic Name and Address
Health Insurance Provider / Health Insurance Policy Number
Please indicate any medical conditions, medications, allergies, dietary needs, behavior issues, learning or physical disability, or special conditions that CRITFC staff should be aware of (attach additional sheet if necessary):
Certification
Parent/guardian initials required for both items / I verify applicant, to the best of my knowledge, will be able to handle 5 days and 4 nights away from home.
INITIALS:______
I verify applicant is able to safely participate in swimming activities.
INITIALS:______
Signatures
Please read carefully before signing. / I hereby certify that all of the information provided by me in connection with my application is truthful, accurate, and complete to the best of my knowledge.
I understand that this is a preliminary application and not a guarantee for camp participation.
Applicant signature / Date
Parent/Guardian Signature
Submission / Please submit this application, signed consent forms, andessay to: / Columbia River Inter-Tribal Fish Commission
Attn: Tana Atchley
700 N.E. Multnomah St., Suite 1200
Portland, OR 97232
Email: Fax: 503-235-4228

Salmon Camp Essay

COLUMBIA RIVER INTER-TRIBAL FISH COMMISSION / FORM CAMP-ESSAY
IMPORTANT: Please answer each question thoroughly. Application will be incomplete without the essay and will not be considered. (Additional pages can be added, if necessary)
1. Introduce yourself and explain why you’re interested in participating in Salmon Camp.
2. Describe your favorite classes, extracurricular activities, and hobbies.
3. What problems do you want to solve when you grow up? What will you need to learn to be able to do that?

Salmon Camp Parental/Guardian Consent and Releases Agreement

COLUMBIA RIVER INTER-TRIBAL FISH COMMISSION / FORM PARENT-AGR
Agreement
To be completed by the parent or legal guardian of the Salmon Camp applicant. / As the Parent/Guardian of , I give my permission for him/her to participate in the Columbia River Inter-Tribal Fish Commission (CRITFC) 2017 Salmon Camp. By signing this agreement I acknowledge that CRITFC has my permission to drive my child in the program vehicles and include my child in all of the Salmon Camp activities unless otherwise specified.
In the event my child is injured or should require medical attention, my signature below does hereby consent to any and all medical and surgical treatment including anesthesia and operations, which may be deemed advisable by his or her physicians and surgeons to perform all examinations. I also agree that I will be responsible for any and all medical or hospital fees or costs associated with my child’s treatment that are not covered by my insurance.
CRITFC will not be held liable for any injuries or accidents caused to my child if he or she chooses not to follow CRITFC staff directions or rules. I assume all risks and hazards related to participation in program activities, including transportation to and from said activities and hereby waive, release, absolve and indemnify and agree to hold harmless to CRITFC and its affiliates for any claim arising out of accidental injury to my child.
I grant CRITFC the right and permission to use and publish the photographs made during my child’s participation in the CRITFC Salmon Camp 2017 program, and I hereby release CRITFC from any and all liability from such use and publication.
I also understand that I am responsible for making arrangements for picking up my child if it is deemed necessary that he/she be sent home by CRITFC staff for any of the following reasons: inappropriate behavior, violation of CRITFC conduct codes, damage to property, or for the overall safety of students, staff and the program.
My signature below indicates that I have read, understand and agree to the terms of the Consent and Releases Agreement Form.
Parent/Legal Guardian Signature / Date
Parent/Legal Guardian Printed Name

Salmon Camp Student Agreement

COLUMBIA RIVER INTER-TRIBAL FISH COMMISSION / FORM STUDENT-AGR
Agreement
To be completed by the Salmon Camp applicant. / I, , by signing this contract, agree to abide by all rules and regulations, as well as actively participate in the Columbia River Inter-Tribal Fish Commission (CRITFC) 2017 Salmon Camp. I understand that failure to comply with camp rules will result in disciplinary action and possible dismissal from the program. I will be respectful of my fellow Salmon Camp participants and I will follow the leadership and requests of the CRITFC staff at all times. I agree to actively participate in all camp activities and maintain a positive attitude while attending Salmon Camp.
Applicant Signature / Date
Applicant Printed Name