Tamaya Hiking Club -Registration Form

The Tamaya Hiking Club is a teen outdoor program aimed at connecting youth to language and culture learning through outdoor experiences. Teens can partake in activities such as visiting cultural sites, national park/monuments, and exploring various outdoor interests.  

Teen participants are encouraged to attend weekly drop-ins at the library. Drop-ins will include scheduled hikes at local trails or within Tamaya and workshops on various topics. Incentives will be provided for attendance. Each month participants will take a program planned trip. Schedule will be forthcoming.  

For more information, please contact Cassandra Zamora at (505)771-6736 or cassandra.zamora@psaedu.org.

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Name of Child *
Age *
Date of Birth *
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Grade of School Year 2023-24
Parent/Guardian Name *
Parent/Guardian Contact Number
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Parent/Guardian Email Address
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Parent/Guardian Name
Parent/Guardian Contact Number
Emergency Contact #1 Name (Other than Parent)
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Emergency Contact #1 Phone Number* 

Please label cell, work, home, etc

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Emergency Contact #2 Name (Other than Parent)
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Emergency Contact #2 Phone Number

Please label cell, work, home, etc

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Is your child vaccinated?

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Size of shirt
Size of jacket
Medical Emergency Information
Please provide as much information about your child for medical reasons.
Hospital
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Physicians Name
Physicians Phone Number
Insurance Policy Company
Policy Number
Is your child allergic to any medications?
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Is your child allergic to any foods?
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Is an EPI PEN needed?*

If yes, EPI PEN will need to be provided to the Library Staff.

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Please let us know of any physical and/or emotional issues in order to provide appropriate accommodations for your child.
In the event that my child becomes ill or injured and I am not available to take action necessary for the well-being of my child, I hereby authorize, Pueblo of Santa Ana personnel to take action necessary for the safety and well-being of my child, including securing medical treatment (at my expense)

Parent and/or Guardian Initial
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I hereby release the Pueblo of Santa Ana and its respective offices, directors, employees, and agents from and against all claims, damages, liabilities, alleged or actual, which may occur in the normal participation of my child in the Tamaya Hiking Club.

Parent and/or Guardian Initial

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I hereby give permission to utilize images of my child(ren) captured during regular and planned activities. This includes pictures by video, photo and digital camera. These photos will be used for the purposes of the Tamaya Hiking Club and Santa Ana Department of Education materials, publications, and social media, and I waive my rights of compensation or ownership thereto. Even if I do not approve photos to be utilized, they may be taken.

Parent and/or Guardian Initial

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In the event that my child becomes ill or isn't feeling well, I understand that my child must refrain from club activities and will provide notice to Library staff. Masks are not required but optional.

Parent and/or Guardian Inital
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I have read and understand the policies and procedures of the Tamaya Hiking Club as outlined above.

Parent and/or Guardian Signature and Date

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