NFR-001-23 Educational Pathways – NFR Family Wellness

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Educational Pathways

Now includes
• After School Program • Tutoring • Youth Empowerment •

Welcome to Educational Pathways
for the
2022-2023 School Year
The application for Educational Pathways is quite long.
There is 9 sections to fill information about you and your youth(s).
We have shorten the form so you don't have to repeat your information that is on the paper version. FYI the paper version is 14 pages long.
If you prefer a paper version we can get you one. Just call the Family Wellness Department at (559) 877-7277 and anyone will be able to help get you a paper application.

Click on the "Next" button to start the application process.

North Fork Rancheria Tribal TANF Family Wellness Youth Center Facility Rules & Computer Use Agreement

North Fork Rancheria Tribal TANF Family Wellness Youth Center Facility Rules & Computer Use Agreement The North Fork Rancheria Tribal TANF Family Wellness Youth Center is a valuable resource center that may be used to conduct job searches, research health related questions and to access academic assistance. To ensure that the computers/ equipment remain in good condition the following guidelines must be followed and agreed upon.

• All members must sign in upon arrival.
• Use of staff phones and/or computers, unless authorized, is prohibited.
• Any person using foul language and/or displaying rude or threatening behavior to other clients or Family Wellness staff will be asked to leave the Family Wellness Youth Center immediately.
• Family Wellness Youth Center materials (books, videos, etc.) may not be removed from the premises.
• The Family Wellness Youth Center and staff are not responsible for any lost/misplaced or missing personal items.
• Use of FWYC computers is limited to: a.) finding employment, i.e., conducting a job search or writing a resume, etc., b) access to the internet to conduct research regarding heath related questions/issues, c) research relating to academic improvement (assignment, academic tutorials, tests, etc.) and to access email accounts of the member.
• Do not download any sites, programs, games, music, etc.
• Do not change the settings on computers for any reason
• No “ADULT CONTENT” websites may be accessed at any time in the NFR Family Wellness Youth Center.
• Do not use or install CD’s, diskettes unless authorized.
• No food or drinks may be near or on the computers, equipment, workstations.
• In the event that there is a waiting list for computer use, members will be limited to 20 minutes of use at a time.
• Remember to always LOG OFF.
• No social networking sites (My Space, Facebook, etc.) or chat rooms shall be accessed at any time during use of NFR FWYC computers.
• Disregarding any of the above guidelines may result in your privileges to the NFR Family Wellness Youth Center being revoked on a temporary or permanent basis.

Type your Signature *

Required

Informed Consent and Disclosures and Rules

I understand that the services and rules provided at the Family Wellness Youth Center may include the following:

• No cell phone usage unless in the case of an emergency.
• No Verbal or physical abuse towards any persons or staff attending Family Wellness Youth Center events is allowed.
• No swearing is permitted.
• Please sign in and for all family members in attendance.
• Drug and Alcohol Education
• Tutoring, Reading, Computer & Video courses
• Socialization Skills
• Cultural Activities
• Goal Setting
• Talking Circles/Therapeutic Groups
• Smoking Prevention & Education
• Field Trips and outdoor sports (permission for each event will be required from the parent/legal guardian.)
• Abstinence Information, Pregnancy Prevention, and Reproductive Education
• Arts, Crafts, Recreational Activities
• Gang Prevention
• STD & HIV Education/Prevention
• Computer & Internet Access
• Holiday Events

I authorize the Family Wellness Youth Center staff, volunteers, and consultants to assist, teach, inform, and involve participant/child in the above services. *

Type your Initial

My participant/child can participate in all of the services mentioned above except for: *

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Type what program exemptions services mentioned above

I give permission to the Family Wellness Youth Center to transport my child for activities as verbally requested by a parent/legal guardian. *

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I understand that some or all participant’s/child’s personal information may be shared among the Family Wellness Youth Center professional staff or referral agencies in order to better serve my participant/child. *

Type your Initial

I understand I will not be charged for Family Wellness Youth Center services. *

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Type your Signature *

Type your Initial

Release and Waiver of Liability Assumption of Risk and Indemnity Agreement

(Read Carefully Before Signing)

IN CONSIDERATION of being allowed to participate in activities sponsored by the Family Wellness Youth Center (“FWYC”), a governmental program owned and operated by the North Fork Rancheria of Mono Indians of California (“Tribe”), a federally recognized Indian tribe, including activities utilizing the use of fitness equipment, a climbing rock wall, bicycles, action sports, and other recreational activities (“Activities”) that may pose risks known or unknown to me, I hereby understand and agree to this release and waiver of liability, assumption of risk and indemnity agreement (“Agreement”) in accordance to the terms hereof as follows:

1. I take full responsibility for, and RELEASE AND HOLD HARMLESS FWYC, the Tribe, its officers, elected officials, affiliates, subdivisions, agents and employees (individually or together, the “Released Parties”) from any and all liability, claims, demands or causes of action that I may hereafter have for injuries or damages arising out of my participation in Activities, included, but not limited to, losses caused by the NEGLIGENCE OF THE RELEASED PARTIES or otherwise.

Initial Here *

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2. I further agree that I WILL NOT SUE OR MAKE CLAIM AGAINST THE RELEASED PARTIES for damages or other losses sustained as a result of any injury, or death, sustained from my participation in Activities. I also agree to INDEMNIFY AND SAVE AND HOLD HARMLESS THE RELEASED PARTIES from all claims, judgments and costs, including attorneys’ fees, incurred in connection with any action brought as a result of participation in Activities by any of the undersigned.

Initial Here *

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3. I hereby expressly recognize that this Agreement is a contract pursuant to which I have released any and all claims against the Released Parties resulting from any injury, or death, sustained from participation in activities including any claims for negligence of the Released Parties.

Initial Here *

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4. I acknowledge that the various Activities (as defined above and covered under this Agreement) are subject to mishap and even injury to participants, including the potential for permanent paralysis and death. I understand and acknowledge that such Activities have inherent dangers that no amount of care, caution, instruction or expertise can eliminate and I EXPRESSLY AND VOLUNTARILY ASSUME ALL RISK OF DEATH OR PERSONAL INJURY OR PROPERTY DAMAGE SUSTAINED WHILE PARTICIPATING IN ACTIVITIES WHETHER OR NOT CAUSED BY THE NEGLIGENCE OF THE RELEASED PARTIES.

Initial Here *

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I HAVE READ THIS AGREEMENT AND FULLY UNDERSTAND THE TERMS. I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, HAVE SIGNED IT FREELY AND VOLUNTAIRLY WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME, AND INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.

Type in your Signature *

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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.

Cell/Mobile Phone Number

(optional)

E-Mail Information
We use digital communications to contact you for any program updates or events

E-Mail Address *

REQURIED FOR CONTACT, ZOOM OR ANY TYPES OF COMMUNICATION

Terms of Services

I Agree with the following Terms

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 or 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.

Signup
Educational Pathways

Now includes
• After School Program • Tutoring • Youth Empowerment •

Adult One

Adult Two

Adult Three

Adult Four

SignupEducational Pathways

Now includes• After School Program • Tutoring • Youth Empowerment •

Adult One

Adult Two

Adult Three

Adult Four

Signup
Educational Pathways

Now includes
• After School Program • Tutoring • Youth Empowerment •