2015 Lakota Summer Institute - Children’s Camp Registration

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2015 Lakota Summer Institute Youth Language and Culture Day Camp

Sitting Bull College - Fort Yates, ND June 1 – 19th, 2015

Monday – Friday, 9:00am – 4:15pm Daily

Registration Due Date: Thursday, May 28, 2015

Please turn in or email complete registration to: SRST Tribal Department of Education – Sunshine Carlow or Nacole Walker

Language Revitalization Program language@standingrock.org

For more information contact Standing Rock Tribal Department of Education: 701-854-8587 or 701-854-8583

Sponsored by:

� Standing Rock Sioux Tribe – Tribal Education Department / Language Revitalization Program � Standing Rock Sioux Tribe – Tribal Historic Preservation Office � Missouri River Educational Cooperative (MREC) � Sitting Bull College � Lakota Language Consortium

Please Note:

� Children must be age 6 – 12 to register for the Day Camp, special circumstances must have prior approval.

� Registration is on a first-come first-serve basis. There is a limit of 40 students at the 2015 Lakota Summer Institute Youth Language and Culture Day Camp; If the limit of students is reached, you will be contacted.

� Priority registration will be given to children with a parent/guardian participating in the Lakota Summer Institute.

2015 Lakota Summer Institute - Children’s Camp Registration

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Camp Registration Form

Camp Dates: (select all that apply)

� June 1 – June 5

� June 8 – June 12

� June 15 – June 19

Child Information Child’s Legal Name:

Date of Birth:

’16-’17 School:

Gender:

Age:

’16-’17 Grade:

Parent/Guardian Information Parent/Guardian 1: LSI Participant? YES NO

Home Address: Work Phone:

City, State, Zip: Cell Phone:

Email Address: Home Phone:

Parent/Guardian 2: LSI Participant? YES NO

Home Address: Work Phone:

City, State, Zip: Cell Phone:

Email Address: Home Phone:

(Other) Emergency Contact Information Emergency Contact

Name: Relationship:

Home Address: Work Phone:

City, State, Zip: Cell Phone:

Email Address: Home Phone:

2015 Lakota Summer Institute - Children’s Camp Registration

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Medical Information

Does your child have any known allergies or medical conditions we should be aware of? Please list:

*Please feel free to attach another sheet if there are any other issues or conditions that you feel we need to be aware of.

Other Information:

Tshirt: (Circle One) Youth: S M L

Adult: S M L XL XXL

I have reviewed this information and certify that everything above is correct, to the best of my knowledge.

Parent/Guardian Printed Name:

Signature: Date:

2015 Lakota Summer Institute - Children’s Camp Registration

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Media Consent/Release Form

Child’s Name: Date of Birth

As parent/guardian, I agree to the following:

I understand that my child may be videoed/photographed at the Lakota Summer Institute Youth Language and Culture

Day Camp.

I understand that these videos/photographs may be used on the Lakota Summer Institute’s Facebook page, Lakota

Language Consortium’s Facebook page, other social media websites, in newspapers, newsletters, and/or in any other

publications/promotional materials.

I understand that such video/photographs shall become the property of the Standing Rock Sioux Tribal Department of

Education, which has the right to duplicate, reproduce, and/or make other uses as the Standing Rock Sioux Tribal

Department of Education deems necessary.

Please check the appropriate statement:

YES, I confirm that I have read and understood the above and thereby give consent for use of my child’s video/photograph as described above.

NO, I do not wish to have my child videod/photographed.

Parent/Guardian Printed Name:

Parent/ Guardian

Signature: Date:

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Camp Rules & Camper Agreement The Lakota Summer Institute Youth Language and Culture Day Camp is based on respect and safety. We expect mutual respect and civility, as well as orderly and safe conduct among all of the individuals at camp. In order to ensure a respectful and fun environment, we require students to respect themselves as well as the rights of others regardless of our differences and where we come from. We ask each one of us to exhibit self-control and to always show humility and courtesy towards each other. The students are expected to adhere to the following rules which apply to everyone. I agree to follow the rules listed below during my time at the Lakota Summer Institute Youth Language and Culture Day Camp,

1. I will show respect for all things (people, plants, animals, property). 2. I will treat everyone with kindness and help make the Day Camp a happy place. 3. I will leave the following at home:

a. food, gum, candy b. cell phones c. iPods, iPads, MP3 players, laptops, and all other portable electronic games or devices d. jewelry or other valuable items e. weapons, including pocket knives or other items that might be seen as a weapon

4. I will respect the camp property, and I will not physically damage or write on any of the camp property 5. I will dress appropriately (practical clothes: shoes, jeans, sweaters).

a. Inappropriate clothing not allowed, such as clothing displaying profanity or slogans which promote tobacco, alcohol, drugs, or are in any other way distracting.

6. I will attend all camp meals, events, and activities. 7. I will show respect and follow the directions of all presenters, adults, and leaders at the camp. 8. I will report immediately to the camp leaders if I am sick or injured. 9. I understand that I could be sent home for the following:

a. fighting b. harassing, hurting, or teasing others c. stealing d. destroying property e. using bad language or gestures f. being involved with pranks g. failure to obey or be respectful to camp leaders or others at camp in charge of my care h. wandering away from the group i. leaving camp without permission j. using drugs, alcohol, or tobacco k. anything that is seen as unsafe to myself or others.

If students continually fail to abide to the above rules, they will respectfully be asked to leave the camp (at the discretion of the camp leaders). Parent/Guardian will be notified and will be responsible for the removal of their child.

I have read and thought about all of these points and agree to abide by this agreement during my time at the Youth Language and Culture Day Camp. The Day Camp reserves the right to dismiss any camper whose influence is considered

detrimental to the overall camp program. Camper’s Signature Date:

Parent/Guardian

Signature: Date:

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Daily Camp Schedule 8:00am – 8:20am BREAKFAST

x Breakfast is available at the Standing Rock Community School x NOTE: Transportation to Breakfast is not provided by the Youth Language and Culture Day Camp -

Parent/guardian must provide transportation to and from breakfast location! 9:00am – 11:30am MORNING SESSION

x Morning session is located at the Sitting Bull College Family Support Center

x Morning session will consist of Lakota/Dakota language related games and activities 11:35am – 12:00pm LUNCH

x Lunch will be available at the Standing Rock Community School x NOTE: Students will walk to the Standing Rock Community School when the weather is nice, in the

event of inclement weather SBC transit will be utilized 12:30pm – 4:15pm AFTERNOON SESSION

x Afternoon Session is located at the Sitting Bull College Family Support Center x Afternoon session will consist of various fun activities (camp, traditional, SRST program sponsored)