Dahayoigii 2025 Student Registration

Dahayoigii 2025 Student Registration
Student Information
Student Name*

First NameLast Name
Student Age*
Grade (4th - 12th). *** Student must be in the 4th grade or above****
Is this a Returning Student?*

Yes; Attended in a previous yearNo; New to the program
Student Gender

FemaleMalePrefer not to say
Student Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Legal Guardian Information
Parent/Legal Guardian Name*

First NameLast Name
Relation to Student:*
Parent/Legal Guardian Email*
example@example.com
Parent/Legal Guardian Phone Number*

Area CodePhone Number
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
Program Information
Select Course*
T-Shirt Size (Youth Sizes)*

SmallMediumLargeX-Large
Event Information

Location: Mesa Elementary School US 491 on Mesa Rd. Shiprock, NM (Near Nizhoni Smiles)

Event Hours: Monday June 9, Registration begins at 8:00 am

Monday June 9, 8:30am-3:30pm

Tuesday June 10, 8:30am-3:30pm

*Wednesday June 11, 8:30am-2:30pm

*Lunch & Breakfast provided by the Central Consolidated School District. Please arrive early if you want to eat breakfast (8:00 - 8:45). Snacks will be provided by the Sacred Youth Foundation
Parental Consent and Medical Release:

It is required of the parent and/or legal guardian of the above registered student to sign and submit a Parental Consent Release and Medical Release form upon check in, at registration on June 11th, 2025.
Are there any medical conditions that we should be aware of?*
Please leave a brief description
Should be Empty:

Dahayoigii 2025 Student Registration

Student Information

Parent/Legal Guardian Information

Program Information