Friendship House Association of American Indians of San Francisco
Youth Program Year 2026-2027
YOUTH ENROLLMENT FORM
This registration form must be completed and returned for participation in the 2026-27 Youth Program.
Participant's Name:
Birth Date:
Gender:
Current School of Attendance:
Grade:
Name of Parent / Guardian:
Address:
Email:
example@example.com
Preferred Phone:
Format: (000) 000-0000.
able to receive text messages at this number
Tribal Affiliation:
Doctor's Name:
Phone Number:
Format: (000) 000-0000.
Health Insurance:
Policy or Plan #
Name of Emergency Contact:
Relationship:
Address
Zip
Day Phone
Format: (000) 000-0000.
Night Phone
Format: (000) 000-0000.
Does this participant have any physical, psychiatric, emotional, or behavioral conditions of which the Youth Group should be aware? Please use the back of this form or additional pages to explain, if necessary.
Restrictions on activities:
Regularly prescribed medications and doses:
Allergies or special diet:
MEDICAL AUTHORIZATION:
The health history above has been provided to the best of my knowledge. The person herein described has my permission to engage in all activities except as noted above. The following authorization permits the staff of Friendship House Youth Program to take whatever steps they deem necessary to ensure the wellbeing of my child should a medical emergency occur during a Youth Group activity. Every attempt will be made to contact the child's care-givers and/or Emergency Contact if an emergency should occur.
Parent / Guardian Name
Child Name
Signature of Parent / Guardian
Date
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Month
-
Day
Year
Date
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Friendship House Association of American Indians of San Francisco Youth Program Year 2026-2027
PARENT/GUARDIAN AUTHORIZATION:
PROGRAMS
My child/youth has permission to participate in ceremonies, workshops and other program activities with the Friendship House Staff (Initial Here)
FIELD TRIPS
My child/youth has permission to travel by public transportation and/or walking for field trips, activities, Ceremony, events, and special trips with the Friendship House Staff. (Initial Here)
MEDIA RELEASE:
Friendship House Youth Program has a website where photos and videos from Youth Group events are periodically published. We also have a Youth program bulletin board where we sometimes post photos from events. It is Friendship House Youth Program policy that photos of children are never published with names or other identifying information.
Initial one:
Yes, you can use pictures and videos of my child. I waive any right to royalties or other compensation arising or related to the use of the photographs and videos.
No-please do not print or publish photos of videos of my child online or in any Youth Program-related publications.
GENERAL RELEASE:
I/We hereby grant permission for my/our child to be a member of the Friendship House Youth Program and to participate in activities arranged by the staff in this regard. We recognize the importance of the commitment that he/she makes and that their participation as a part of a larger community requires responsible behavior. Therefore, I/we agree that if this child engages in behavior which, in the judgment of the staff, is not in the best interest of the program, our/my child or any member of the group may be asked to leave the program. I release the Friendship House Youth Program and the Friendship House Association of American Indians, participating agencies, staff and volunteers from all liability in case of theft, damage, or accidents of my child and his/her personal belongings which may occur during program activities. I understand that program schedules will be provided at the beginning of each month. Permission slips for specific outings and events will be provided at the same time as the calendar for outings and events that take place that month. All permission slips are due one week prior to a scheduled event or outing. I understand that if my child does not return a permission slip by the due date, they will be unable to attend the outing/event.
Signature of Parent(s)/Guardian(s)
Name of Parent
Date
-
Month
-
Day
Year
Date
EQUIPMENT AGREEMENT FORM:
I, understand that Friendship House Youth Program is loaning a computer for my child in order to participate in the Learning Hub. I understand that while the equipment is in my possession, I am solely responsible for the equipment lent to my child. I agree that any equipment lost or damaged in any way or manner at any time, while attending the hub will be my responsibility. As a good sign of faith I hereby promise to take care of all equipment ONLY in a manner consistent in which it was intended for. I promise to return all rented equipment in good or same condition prior to leaving this facility.
SIGNATURE OF PARTICIPANT
DATE
-
Month
-
Day
Year
Date
SIGNATURE OF PARENT/GUARDIAN (IF UNDER 18 YRS OF AGE)
DATE
-
Month
-
Day
Year
Date
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Friendship House Association of American Indians of San FranciscoYouth Program Year 2026-2027
Hub Information:
1. Your child's log in information for school
Username:
Password:
2. Does your child have an IEP?
Yes
No
If yes, does your child need help with anything specific?
3. What platform does your child use?
4. Please give us a copy of your child's schedule
5. Is there any other additional information you would like us to know about your child's schooling?
YOUTH PROGRAM EXPECTATIONS:
Respect your peers: avoid teasing, talking at the same time as your peers, name calling, etc.
Treat the property with respect: no damage, clean-up after yourself, etc.
Youth group is not the time for kissing, flirting or other sexual behavior
Support the staff and your peers with full participation: looking at who is speaking, asking questions, contributing answers, etc.
Remain with the youth group unless a staff member gives you permission to leave the group
During talking circles, all electronic devices must be out of sight and not in use; including phones, iPods and other mp3 players, e-readers, tablets, laptops, etc.
Follow any additional rules or directions discussed by Staff/Youth leaders
There will be a Zero Tolerance policy for the following rules. If a rule is broken once, you and your parents will be told that you will not be able to participate in the Youth Program until further notice.
Drugs, alcohol, tobacco, and weapons are NOT tolerated or allowed in the youth room or other places we meet as a youth group. If a staff member is informed that a youth member has one of these items, we will ask you to show us what is in your bag or we will need to call your guardian to check your belongings for you
Violence is NOT tolerated: this includes: hitting, kicking, punching, biting, or any other form of physical assault
Any observed or reported act of inappropriate sexual behavior is strictly prohibited
I understand that I am expected to follow the guidelines of this contract if I wish to attend the Friendship House Youth Program. If I have questions or concerns, I will come to one of the staff members.
Participant Signature
Participant Name
Date
-
Month
-
Day
Year
Date
Parent Signature
Parent Name
Date
-
Month
-
Day
Year
Date
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