Cultural Department Traditional Arts Application
Class Name
Month/Year
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Sex
Male
Female
Age
Choose one of the following
PCI Tribal Member
1st Generation Descent
Tribal Household Member
Tribal Employee
Tribal Roll Number
Copy of 1st Generation Descent Letter
Browse Files
Drag and drop files here
Choose a file
Cancel
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Are there any substances, materials, or foods that you are allergic or sensitive to?
Yes
No
Please list them here.
Do you have any special needs, such as wheelchair access?
Yes
No
If yes, what can we do to help you out?
Have you participated in any Traditional Arts classes before?
Yes
No
Please list the classes here.
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Emergency Contact Information
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Relationship
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Relationship
Date
-
Month
-
Day
Year
Date
Signature
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