YDP Enrollment Form 2025-2026

The mission of the Youth Development Program is to provide Muckleshoot tribal members, Muckleshoot descendants, Muckleshoot tribal member household, native youth attending Muckleshoot Tribal School living in the community, and native youth who live in Muckleshoot Tribal Housing Authority going into the 2nd through 12th grade, who are enrolled in school, with a safe environment for after school activities and events. The Youth Center will be available for youth going into 2nd grade through 5th grade. The Teen Center will be available for youth going into the 6th grade to high school senior and/or 18 years old.

Each participant needs to be able to walk a mile daily, use restrooms with NO assistance, feed themselves, have clear communication and must be able to participate fully in a large group setting (10-20 kids).

YDP provides limited transportation within the Muckleshoot Reservation and immediate surrounding areas.

Summer Camp transport: Pick-up at 9:00 AM | Drop-off at 5:00 PM

School Year transport: Evening drop-off at 8:00 PM (Mon–Thu) and 6:00 PM (Fri)
For enrollment questions please contact YDP Enrollment: Ginger Starr, 253-876-3383, ginger.starr@muckleshoot.nsn.us
Parent/Guardian Information
Primary Parent/Guardian*

Frist NameLast NameTribeEnrollment #
Secondary Parent/Guardian

Frist NameLast NameTribeEnrollment #
Primary Address*

Street Address

Apt/Unit #

CityState / Province

Postal / Zip Code
Home Phone*
Cell Phone
Work Phone
Ext
Email Primary*
example@example.com
Participant Information
Name*

First NameLast Name
Other Name Child Goes By
School*
Date Of Birth*

MonthDayYear
Date
Age*
Entering Grade*
Gender*

MaleFemale
Select one*

Muckleshoot tribal memberMuckleshoot descendantLiving in tribal household
Enrollment #
Does this child have an IEP?*
Details on IEP
Name

First NameLast Name
Other Name Child Goes By
School
Date Of Birth

MonthDayYear
Date
Age
Entering Grade
Gender

MaleFemale
Select one

Muckleshoot Tribal MemberMuckleshoot DescendantLiving in Muckleshoot Household
Enrollment #
Does this child have an IEP?
Details on IEP
Name

First NameLast Name
Other Name Child Goes By
School
Date Of Birth

MonthDayYear
Date
Age
Entering Grade
Gender

MaleFemale
Select one

Muckleshoot Tribal MemberMuckleshoot DescendantLiving in Muckleshoot Household
Enrollment #
Does this child have an IEP?
Details on IEP
Name

First NameLast Name
Other Name Child Goes By
School
Date Of Birth

MonthDayYear
Date
Age
Entering Grade
Gender

MaleFemale
Select one

Muckleshoot Tribal MemberMuckleshoot DescendantLiving in Muckleshoot Household
Enrollment #
Does this child have an IEP?
Details on IEP
Transportation

Parent drop-off and pick-up is encouraged.
Will your child use YDP transport?*
Y/N
Alternate drop-off address

Street Address

Apt/Unit #

CityState / Province

Postal / Zip Code
Alternate contact information

NamePhone NumberRelationship
Please provide names of those individuals able to pick-up your child:
Name

NamePhone NumberRelationship
Name

NamePhone NumberRelationship
Name

NamePhone NumberRelationship
Please provide names of those legally restricted from picking up your child:
Name
Name
Name
Emergency Contact Information

Use this area to identify who we may contact in the event of an emergency, and please identify whether they can also be an alternate drop off location if you utilize YDP’s transportation.
Emergency Contact 1*

NamePhone NumberRelationshipAlternate Drop-off? Y/N
Emergency Contact 2*

NamePhone NumberRelationshipAlternate Drop-off? Y/N
Field Trip/Offsite Activity Permission

The YDP Youth & Teen Center will tentatively plan to go on weekly field trips throughout the summer from 10:00 am to 3:00 pm. If the participants indicated on this enrollment form are under the age of 18, a parent/guardian must agree and consent to the following terms and conditions:
As the parent or legal guardian I do hereby give my consent and agree that my child/children may participate in the YDP offsite activities/field trips. My signature below is my affirmation that I have read the terms of this agreement, that I understand the terms and conditions, including my duty to provide adequate medical coverage; to explain to my youth the dangers and risks of attending this activity; and to explain and direct him/her to obey all the rules and guidelines as set forth by the Youth Development Program staff and volunteer chaperones for this off site activity.
I understand that the Youth Development Program and its staff are not physicians or medical practitioners. With this knowledge in mind, I expressly consent to and allow the staff to provide, through medical staff of its choice (unless otherwise indicated), necessary medical treatment, first aid, and emergency medical healthcare as deemed necessary with respect to any injury or medical condition that may be observed during the course of the participants involvement in the programs activity.
I understand that there are risks inherent in participating in the Youth Development Program and related activities. I further understand that the safety precautions provided for the participant and the areas where the Youth Development Program takes place may result in or contribute to injury. Therefore, I hereby voluntarily and knowledgeably assume all risks inherent in participating in the program related program activities and further acknowledgement that neither the Youth Development Program nor Muckleshoot Indian Tribe has a duty to guard against such risks.
I hereby release the Youth Development Program, their respective staff, employees, and adult volunteers from any liability arising out of any negligent act or action that results in any loss, injury, or damage that may occur as a result of or relates to participation in the program.
The YDP strives to participate and engage with the community when it is safely possible. There are times when the YDP may participate in local offsite events such as tribal/ceremonial dinners, MTS events, and other seasonal events. The YDP may also host alternate activities at local MIT Campuses (Local MIT Campuses include but are not limited to: HWC/Ball fields/PSB/MTS/Powwow grounds/Tribal College/KC Library) as well as local parks (Local parks include but are not limited to: Game Farm/Les Gove/Flaming Geyser/Mud Mountain Dam).
Field Trip Authorization Parent/Guardian signature*

Clear
Medical Information
Please list any significant health concerns, allergies, and/or other problems that camp staff should know about your child
Please list any medications your child is currently taking:

Medication NameDoseHow Often
If your child will require medication during an emergency, please make sure you contact the Program Manager of whichever program your child will be attending through to fill out any necessary forms AND provide an emergency supply to the program.
Medical and Photo Releases

I hereby grant permission to the Muckleshoot Indian Tribe and their respective agents and employees to secure such medical aid and hospital services as they deem necessary for the child noted on this form in the event that he/she should sustain injury or illness while attending the Youth Development Program. I agree to assume the cost for transport and medical treatment in such an emergency situation.
ParentGuardian Signature*

Clear
Date*

MonthDayYear
Date
I hereby grant permission to the Muckleshoot Indian Tribe and their respective agents and employees the irrevocable and unrestricted right to produce photographs and video taken of my child. These photos and/or videos will only be used in projects, published in tribal publications, and/or posted on social media.
ParentGuardian Signature

Clear
Date

MonthDayYear
Date
Skate Jam and Skate Clinic Liability Waiver
Liability Disclaimer: I release, indemnify, and hold harmless Alchemy from all liability in connection with any injury in conjunction with the participation activity (ies) which include all activities connected to skateboarding. I acknowledge that there are potential risks associated with Skateboarding. I appreciate and assume all risks associated with participating in these events.

I certify that I am in good health, able to participate in activities, and competent to enter this release. (If under 18 years of age, a parent or guardian MUST sign this release). I have read the foregoing release, authorization and agreement, before entering my full name (or electronic signature) below and warrant that I fully understand the contents thereof.

Publications Release: Photographs and video are often taken over the course of programs, including drop in hours, at Alchemy Skateboarding by community members and staff. I give Alchemy Skateboarding permission to photograph me and use my picture in any medium for any purpose. I hereby waive any right to approve the finished products.

COVID-19 Participation Rules: I will act in accordance with all local and state gov. recommendations in regards to COVID-19. I also acknowledge that I am to my best knowledge not suffering from fever or flu like symptoms.
Parent/Guardian Name
First and Last name
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date
Participant Rules and Expectations
Participants in the Youth Development Program are expected to conduct themselves in a manner that is cooperative with the group. Each participant will be expected to be able to participate in a large group setting, appropriately participate in offsite field trips, and be able to stand, walk, and sit for a general period of time conducive to participating in activities. However, a participant’s refusal to follow directions given to them by the staff creates an atmosphere that is disruptive to the program and will result in disciplinary action. In order to ensure a safe and secure program for all participants of the Youth Development Program, all youth will strive to fulfill the following:

* Respect each other

* Respect the staff

* Respect the facility and equipment

* No tolerance for drugs, alcohol, weapons, or roughhousing/fighting

* No inappropriate language

* All participants must check in upon arrival

* All participants are expected to report all unsafe or illegal activity to the staff immediately

* All participants are expected to dress appropriately: No open toed shoes, No gang attire, No spaghetti straps, No clothes with inappropriate graphics,

* All participants are expected to clean up after themselves (meals, activities, and use of equipment)

* Food must only be eaten in designated areas

* When offsite all participants are expected to stay with their assigned group (failure to do so could result in removal from future offsite activities)

* No public displays of affection

If the above guidelines are not followed, the following behavior consequences may occur:

1st incident: Verbal warning and written notice home

2nd incident: Suspension for 1-2 days; will be determine by leadership staff

3rd incident: Suspension for 3 or more days; will be determined by leadership staff based on incident; will require a youth success plan upon return

There are some situations that may occur where verbal and written warnings may be bypassed, and the participant may be suspended for their actions. This may include displaying physical violence (i.e. fighting), damaging MIT property, and/or other serious behaviors that are not tolerated at the Youth & Teen Center, as determined by the YDP Supervisor or designee.

If the participant’s behavior continues to be disruptive to the program after following the above behavior consequences, the Youth Development Program reserves the right to withdraw the participant from the program. This is only after repeated behavior violations, discussions with the participant and parents/guardians, and multiple attempts to correct the behavior.
Parent Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Parent/Guardian Information

Participant Information

Transportation

Emergency Contact Information

Field Trip/Offsite Activity Permission

Medical Information

Medical and Photo Releases

Skate Jam and Skate Clinic Liability Waiver

Participant Rules and Expectations