RHT After School Program Zuni Middle School
ZYEP’s After School Program “Rooted in Healthy Traditions” will promote cultural and social connectedness and holistic wellness by connecting Zuni youth to positive, intergenerational mentors in programming that emphasizes traditional physical activity, art, nutrition/farming/ cooking, and Zuni language.
  • Zuni Middle School
  • Grades: 6th, 7th, 8th
  • Time: 3:00-5:00pm
  • Tuesday/ Wednesday/ Thursday
  • Dates: February 6th - April 25, 2024
Students cannot be in any other extracurricular activity, i.e., tutoring or sports.

Please fill out the form completely. We will call you to confirm your attendance in the After School Program.
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Student Name *
Grade *
Date of Birth *
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Gender *
Address *
I participated in last year's RHT After School Program *
Crew Teacher  *
Shirt Size (Adult sizes)  *
Language spoken at home *
Name of Parent/guardian/care provider *
Relationship to Student *
Homephone/Cellphone  *
(Adult) Email address
2nd parent/guardian/caregiver *
Relationship to Student *
Phone number
Emergency contact name/relationship (different from above) *
phone number *
Does your child have an IEP or 504 Plan? if yes, we will reach out to discuss. *
Does your child have allergies/food allergies? If yes, please list *
Will your child need transportation after the program ends at 5pm?  *
If yes, list Address to be dropped off at:
Describe any additional information that will be important for the staff to know about your child (access requirements/special accommodations). *
Please list authorized individuals who may pickup the participant. Name of person, relationship, phone number *

Please read this form carefully and be aware that as the parent of a minor child in this program, you will be waiving and releasing all claims for injuries, loss of property, and/or negligent acts.

As the parent of a minor child in the program, I recognize and acknowledge that there are certain risks of injury and I agree to assume this risk which my minor child/ward may sustain as a result of participating in any or all activities connected with or associated with such a program.

I agree to waive all claims that my minor child may have as a result of participating in the program against the Zuni Youth Enrichment Project (ZYEP) and its officers, agents, servants, and employees. In order to minimize risks, I will take responsibility to see my minor child is prepared for all activities and is in good health each day of the session. If the child presents a cough or is feeling ill, we will notify listed contacts.

In case of a medical emergency, I give my permission to the adults in charge of the ZYEP program to secure emergency medical treatment for my minor child, as needed.

I give permission for my minor child to be photographed and have work samples used as part of ZYEP promotions, publications, and fund-raising activities.

I give permission for my minor child to participate in a short survey and Body Mass Index measurements related to the program. My child’s experience in the program will help ZYEP shape future programs and my child’s experience will be shared with me at the end of the program.

I give permission for my child to be transported either by ZYEP transportation or by other commercial or public transportation for program activities- we will do field trips for the duration. My child will abide by all rules and regulations of the ZPSD and ZYEP transportation policies. 

I understand that the program follows all of the rules of  ZPSD and I understand that ZYEP has the right to terminate services for behavior and other issues that happen before, during and after school.

I have read and fully understand the above Waiver and Release of All Claims.

Please sign below:

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