2025 Youth Warriors Circle Waiver Form

This years camp will be in Aptos,Ca.

Dates: June 12-15, 2025

For those needing a ride from San Jose to the camp, please meet us between 8:00AM-10:00AM on Thursday June 12 at

2772 Monterey Rd, San Jose, Ca 95111

For those needing a ride from Los Banos to camp, the location is TBD but you will be contacted at a later date.

Camp Location

Barrios Unidos Walter Guzman Retreat Center

3900 Fern Flat Rd. Aptos, Ca

We are excited to provide a free cost camp to local youth! With that said, we do not allow family to come in and visit for the day or camp due to limited space and to have them fully focused on the experience. If you happen to have an educational workshop or ability to help out, please contact Felipa or Naiche as soon as possible. If you are dropping off your child you will be able to say good bye during camp setup, but we ask that you understand we start after they put their items away and set up their bed.

All youth are assigned tribes on arrival and some of the older youth are made 'tribal leaders' to help facilitate some of the tasks, workshops and to help keep the day to day running smooth.

Each day we will have a couple of workshops & sweat lodge ceremony(Please bring a towel and appropriate clothing as mentioned below). We break the youth up into girls only and boys only sweats. Our sweats are meant to be an introduction to ceremony and so we do not get it overly hot but we do require each youth to participate.

We will be putting everyones phones away for the duration of the camp. They will have the ability to send a text or make a call on arrival, and then at the very end of the camp to take photos with friends or call parents/guardians.

**Required Items**

1 blank white shirt per child

Sweatpants & Sweater for evenings

Pillow & Blankets/sleeping bag

A change of clothes for each day

Any medication or vitamins that they need

Travel Toothbrush, Travel Toothpaste & Body Wash

Shower or Beach Towel

Boys: swimming or basketball shorts

Girls: Long Skirt or Sport shorts with *extra* towel

*Optional*

Sleeping Mat

Flashlight

Water Shoes

If you have any questions, please call:

Felipa: (669)225-0073 or Naiche: (209)509-7824

Name of the Child*

First NameLast Name

Age

If more than one child, please add their Name and Age:

for multiple, please separate by commas

If any allergies or special medical needs, please type them below

Specific medicines that they will need or help that might be needed

Name of the Parent/Guardian*

First NameLast Name

Parent/Guardian's Cell Phone Number*

Parent/Guardian's Email*

we will send you a confirmation email for your records

Parent/Guardian's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Statement of Consent & Waiver

I hereby agree and declare that I am the legal parentguardian of the above-named child and hereby consent to the child's participation in the activities that are described to me in registration process. I understand that activities of the kind described may result in physical injury to my child but nonetheless specifically request that he or she be allowed to participate in those activities.

If the above-named child requires any emergency medical treatment or procedures during the activities, I hereby consent to activity supervisor(s) to make any decision and take any action to arrange for such procedures or treatments in the discretion of the activity supervisor(s).

I, the parent/guardian, hereby agree and declare that I have carefully read and understand the scope of the Youth Warriors Circle activities and I consent to the participation of the above-named child to these activities.

Any type of injury that may occur to the child without the fault of the camp management and activity supervisors, the camp management cannot be held responsible for any harm that may occur to the child without the fault of the camp management and activity supervisors.

Parent/Guardian Signature

Please verify that you are human*