NAYA Spring Culture Nights 2026

NAYA Spring Culture Nights 2026

Important Registration Information

Please sign up only if you know you will be able to attend.
- Culture Night sign-ups will be released three (3) events at a time.
- Every person attending must have their own registration.
  - Example: If you are bringing 4 people, you must complete 4 separate sign-ups—one for each adult, youth, or elder.
- Adults bringing children must also sign themselves up. Adults are expected to actively participate and help their children complete the activity.
- Youth under 16 must be accompanied by an adult. It is VERY important to have any youths' Synergy Number (same as their lunch ID) AND name of their school.
This registration form will remain open until until capacity is reached.
Each participant must be registered individually; click next to the ONE activity you are signing up for. If it says "none" we are unfortunately at capacity.*
Participant's Legal Name*

First NameLast Name
Participant's Preferred Name (if different from above)
Participant's Date of Birth*

MonthDayYear
Date
Participant's Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Participant's or Participant's Parent/Guardian Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Participant's Gender*
Any food allergies? If yes, list all. If no, put "none." Note: We can not guarantee that dinner will be allergen-free or that it will meet all dietary needs.*
Participant's Tribal Affiliation
Emergency Contact Information
Emergency Contact 1 (Parent or Guardian if applicable)*

First NameLast Name
Emergency Contact 1/Parent or Guardian Email*
example@example.com
Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Education/School Information

Please fill out all of this section if this is for a youth participating
Youth currently enrolled in school?
Type of school or training program in which youth is enrolled
Youth's current school
What grade will your youth be in during the 2025-26 school year?
Youth's Synergy Number (District ID Number- This is also your child's lunch ID number)
Releases and Consents:

All releases and consent must be completed and signed by a parent or legal guardian or adult participant who is 18 years or older.
YesNo (if no, do not proceed)
Name of parent/legal guardian OR adult participant who is 18 or older completing the below releases and consents*

First NameLast Name
Today's Date*

MonthDayYear
Date
I understand this is a safety precaution and will not attend if I am experiencing symptoms of illness.
Parent/Guardian Signature*
YESNO
Parent/Guardian Signature*
Permission/consent to photograph, video, interviews and quotations: I give consent for myself or my child to participate in NAYA Family Center marketing activities, including interviews, the use of quotes, and the taking of photographs, movies or video tapes by NAYA Family Center employees. I grant NAYA Family Center the right to edit, use, and reuse said products for non-profit marketing purposes including use in NAYA Family Center grant writing and marketing in print, on the internet, and all other forms of media. I also hereby release NAYA Family Center and its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above.*

YESNO
Parent/Guardian Signature*
Transportation is not provided for this event, but this is included as one of NAYA's regular consents. Consent for transportation in NAYA vehicles and NAYA staff vehicles: I understand that NAYA Family Center programs and activities may include local and long distance travel, and give permission to the NAYA Family Center to provide transportation. The participant understands and agrees to abide by the following rules with being transported:· All participants must be responsible for wearing seatbelts at all times.· All children under 80 lbs. are required to be properly placed in a child seat or booster seat.· Appropriate conduct will be mandatory when being transported.· Smoking is not allowed in NAYA Family Center vehicles or personal staff vehicles when being transported. A participant may be subject to suspension of transportation privileges if found in violation of any rules of transportation, or for disobeying the NAYA Family Center staff providing the transportation.*

YESNO
Parent/Guardian Signature*
YESNO
Parent/Guardian Signature*
Consent to emergency care and relevant information: In the event of an emergency, if reasonable attempts to contact persons listed are unsuccessful, I give consent to the NAYA Family Center to transport myself or my child to the doctor or to the Emergency Medical Department of the nearest hospital. If my doctor cannot be contacted, all medical treatments deemed necessary by the attending licensed physician, including examinations, anesthesia, operations, and diagnostic procedures, may be administered. I further acknowledge that I will be responsible for all fees and costs associated with the medical treatment that are not covered by my insurance.*

YESNO
Parent/Guardian Signature*
Release of Liability/Assumption of Risk: (in order for youth to participate, this must be answered "yes." If "No" is indicated, you will be contacted to fill out another form if you'd still like your youth to attend.) By participating in the programs and activities of the NAYA Family Center, I agree to hold harmless the NAYA Family Center, and release any and all rights or claims to damages that may arise in connection with or as a result of myself or my child’s participation in the programs and activities of the NAYA Family Center. This release applies to the NAYA Family Center, including any and all officers, agents, employees, volunteers, sponsors, coaches, and/or damages.*

YESNO
Parent/Guardian Signature*
You will receive a confirmation email to the email listed under "Participant's or Participant's Parent/Guardian Email" above, after finishing the registration. If you do not receive one or have any questions about this form, contact Michaila at michailat@nayapdx.org or 503-288-8177 ext. 267 to confirm before resubmitting.
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