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    • About Family Wellness
      • Atascadero Team
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    • Employment
  • Programs
    • 2nd Annual North Fork Youth Conference – Indigenous Leaders of Tomorrow
    • 4th Annual North Fork Women’s Conference
    • Backpacking 4 Education
    • Career Development
    • Decolonize Your Diet
    • Explore Your Backyard
    • Family Night
    • GONA 2023
    • Indigenous Mothers Talking Circle
    • Jason O’Malley Program
    • MMIW
    • Pride Month 2 Spirit
    • Soaring Eagles Education Program
    • Stand With Our Warriors
    • Strong Family Connections
    • Summer Work Experience
    • Thread of Traditions Anti-Bullying
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Explore Your Backyard

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Program Documents
Pre/Post Test
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Adult Information

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Required (include apt, suite, unit, ect… example 123 any street, apt 1a)
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(If no number use all zero) Required
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(If no number use all zero) Required
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example: (North Fork Rancheria Mono, Chucksansi, Big Sandy, Tachi, None, n/a) [you can add more then tribe if you wish]
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(If not attending school use n/a or None) Required

Adult Household Information

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Emergency Contact Information

Emergency Contact One
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(If no number use all zero) Required
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Emergency Contact Two

Insurance Information

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At Risk Indicators

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Must Include Two Yes
Please Check All That Apply

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Participants Information

(You are already included, Just enter other Participants/Household members)

Maximum Number of Participants is 7

Participant One

Required
example: (North Fork Rancheria Mono, Chucksansi, Big Sandy, Tachi, None, n/a) [you can add more then tribe if you wish] Required
Required
Required
Required
Required
(if not attending use n/a)
Required

Participant Two

Required
example: (North Fork Rancheria Mono, Chucksansi, Big Sandy, Tachi, None, n/a) [you can add more then tribe if you wish] Required
Required
Required
Participants Two Gender
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Required
(if not attending use n/a)
Required

Participant Three

Required
example: (North Fork Rancheria Mono, Chucksansi, Big Sandy, Tachi, None, n/a) [you can add more then tribe if you wish] Required
Required
Required
Required
Required
(if not attending use n/a)
Required

Participant Four

Required
example: (North Fork Rancheria Mono, Chucksansi, Big Sandy, Tachi, None, n/a) [you can add more then tribe if you wish] Required
Required
Required
Required
Required
(if not attending use n/a)
Required

Participant Five

Required
example: (North Fork Rancheria Mono, Chucksansi, Big Sandy, Tachi, None, n/a) [you can add more then tribe if you wish] Required
Required
Required
Required
Required
(if not attending use n/a)
Required

Participant Six

Required
example: (North Fork Rancheria Mono, Chucksansi, Big Sandy, Tachi, None, n/a) [you can add more then tribe if you wish] Required
Required
Required
Required
Required
(if not attending use n/a)
Required

Participant Seven

Required
example: (North Fork Rancheria Mono, Chucksansi, Big Sandy, Tachi, None, n/a) [you can add more then tribe if you wish] Required
Required
Required
Required
Required
(if not attending use n/a)
Required

Messaging/Updates

We use a Messaging Services called “Remind” to send any notifications for example: zoom link, reminders, or updates.
If you would like to receive notifications about the event, provide us with a valid Cell Phone Number.
Message and data rates may apply depending on your mobile carrier.
(optional)

E-Mail

We use a Zoom for our presentation and digital communication to contact you.
REQURIED FOR PROGRAM UPDATE OR COMMUNICATION

Terms of Services

The parent(s) of participant(s) must complete and return this agreement. It is understood that I (the participant) cannot participate in the recreation activities until this WAIVER has been completed. As the legal guardian/parent of a minor participant(s), for myself, my personal representative, heirs, next of kin, spouse and assignees do hereby release and discharge the North Fork Rancheria and all of its programs, employees, agents, Board of Directors, and staff from any and all claims and damages, or property damage while participating in the above activity or attending the above activity which is being financially sponsored by North Fork Rancheria Tribal TANF. I understand that my participation in the North Fork Rancheria Tribal TANF activity or my participation in an activity which is being financially sponsored by North Fork Rancheria Tribal TANF may result in potential harm, injury and/or damage to me or my property. In case of an accident or an emergency, I authorize a staff member of North Fork Rancheria Tribal TANF to take my child to the above-named Physician or to the nearest Emergency Hospital for such emergency treatment and measures as are deemed necessary for the safety and protection of the child at my expense. All allergic reactions to and current medication-taking information must be disclosed on this form.

I have read and hereby agree to abide by the North Fork Rancheria Tribal TANF Activity Rules. I further acknowledge that my participation in the North Fork Rancheria Tribal TANF Activities will be in jeopardy should I fail to adhere to the rules. I give permission for any photos/filming of my child/myself taken while participating in this activity, to be used by North Fork Rancheria and its programs for promotional use, such as but not limited to: newspaper, television, posters, social media, magazines, promotional or educational, etc. I also understand that I will not receive any compensation for such use.

Safety is our first priority. If the behavior of an individual is not appropriate, consequences will be determined by the appropriate North Fork Rancheria Tribal TANF staff member.

North Fork Rancheria Tribal TANF – Code of Conduct: Be helpful, courteous, and respectful to others at all times

Do not use or possess alcohol, tobacco, or other drugs. Check-in with your event leaders, so they know where you are at, at all times. Be respectful of other youth (No fighting, pushing, hitting, or “put-downs”). Be respectful of the environment (No littering or vandalism). No vulgar language will be tolerated. NO PETS ALLOWED

Consequences may include the following: Verbal Warning, Parent Contact, Sent home from an activity at own/parents’ expense, Disqualification from future FW prevention events

I certify that all information reported in this application is accurate to the best of my knowledge and hereby authorize the information to be used by the North Fork Rancheria Tribal TANF Program, for the purpose of Data Tracking. Disclaimer: I understand that my information is confidential and will not be divulged to anyone without my permission.

Electronic Signature Agreement.
By clicking the “Submit” button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By clicking “Submit” you consent to be legally bound by this Agreement’s terms and conditions (hereafter referred to as “E-Signature”). You also agree that no certification authority or other third party verification is necessary to validate your E-Signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature. You also represent that you are authorized to enter into this Agreement for all persons who are in this agreement will be bound by the terms of this Agreement. You further agree that each use of your E-Signature constitutes your agreement to be bound by the terms and conditions of the North Fork Rancheria Tribal TANF.

BY TYPING MY SIGNATURE, I ACKNOWLEDGE THAT I FULLY UNDERSTAND AND AGREE WITH THE TERMS AND CONDITIONS STATED ABOVE.

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Program Documents

Information about Forestiere Underground Gardens: https://undergroundgardens.com/about-us/

  • San Joaquin River Gorge Information

 

Pre/Post Test

Pre/Post Test

Forestiere Underground Gardens Pre/Post Test

– Step 1 of 3

Required


PRE TEST — Explore Your Back Yard – Forestiere Underground Gardens

When you have provided an answer for each question,
Click on Next to see your Post Test.

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Save and Resume Later

POST TEST Explore Your Back Yard – Forestiere Underground Gardens

Here are your Post Test Questions. Once you have completed all questions,
Click on Next to start the Evaluation

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Evaluation

Choose
Poor, Fair, Good, Excellent
When your done, Click on Submit to send in your Pre, Post Test and Evaluation.

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San Joaquin River Gorge Pre/Post Test

– Step 1 of 3

Required


PRE TEST — Explore Your Back Yard

When you have provided an answer for each question,
Click on Next to see your Post Test.

Required


Required


Required


Required


Required


Save and Resume Later

POST TEST Explore Your Back Yard

Here are your Post Test Questions. Once you have completed all questions,
Click on Next to start the Evaluation

Required


Required


Required


Required


Required


Save and Resume Later

Evaluation

Choose
Poor, Fair, Good, Excellent
When your done, Click on Submit to send in your Pre, Post Test and Evaluation.

Required



Required

Required


Required



Required



Required


Required


LoadingSave and Resume Later

Your form entry has been saved and a unique link has been created which you can access to resume this form.

Enter your email address to receive the link via email. Alternatively, you can copy and save the link below.

Please note, this link should not be shared and will expire in 30 days, afterwards your form entry will be deleted.

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