NMARB Youth Ambassador Application

This program is intended for students grades 9-12.

Program calendar:

September 13, 27 1pm-4pm

September 20 tba

October 11, 25 1pm-4pm

November 8, 22 1pm-4pm

December 6 1pm-4pm

December 20 Community event

Program locations will be announced upon registration and held in public creative spaces throughout our community.

Parent Name*

First NameLast Name

Parent E-mail*

example@example.com

Parent Mobile Number*

Area CodePhone Number

Address*

Street Number and NameCity and Zip Code

Student Name*

First NameLast Name

Address*

Street Number and NameCity and Zip Code

E-mail*

Mobile Number*

Area CodePhone Number

Name of school currently attending.

Grade level this year?

Will you have transportation to and from our weekly meetings and community outings? Please be specific on how you will be transported (by whom?)

Tell us about one person in your life who has made an impact and how.*

Is there a place in our community that inspires you and why?*

Is there an NM figure (from the past or present) who inspires you and why?*

Check any of the following that you have an interest in.*

What interests you about this project?

Ambassadors ages 16+ will have the opportunity to apply for UNM dual credit. Are you interested in applying for dual credit in the Fall 2025 semester?

yesno

RELEASE OF LIABILITY. PLEASE READ BEFORE SIGNING.

This agreement releases The New Mexico Academy of Rock and Blues and The New Mexico Youth Arts Ambassador programs from all liability relating to injuries, and/or illness that may occur on site and/or during our workshops and events. By signing this agreement, I agree to hold NMARB/NMYAA entirely free of all liability including finanical responsibility for injuries and illness. I also acknowledge the risks involved in the activity, including and not limited to possible exposure to community spread illness. Additionally, I attest that my child does not have any conditions that may increase his/her likelihood of experiencing injuries or illnes while engaging in these activities. By signing below, I attest that my child will be kept home if any of the following signs are present:

Body Temperature above 100.4

Nausua/Vomiting/Diarrhea

Sore Throat/Cough

Headache/Body aches do to illness

If you child shows any symtoms of illness, please keep them home and do not send them to workshop until they are well. They must be fever free for 24 hours before returning.

Student Signature*

Signature date*

Parent Signature*

Signature date*

Photo Release: I grant permission to NMARB/NMYAA to take the following (check all that apply) of my child for use in promotional or educational materials. These materials might include printed or electronic publications, websites, or other communications. I further agree that my child's name may be revealed in descriptive text or commentary in connection with the image.

Signature

NMARB and Youth Arts Ambassadors FALL 2025-SPRING 2026 Grades 9-12