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Registration

First Name

Last Name

Gender

Age

Tribal Affiliation

HCN District

Volunteer

Placement Parent

Employee Number

Employee Department

Email Address

Cell Number

Shirt Size

Using Admin Leave

Attending Day One

Attending Day Two

Attending Day Three

Camping

Tent

Any Special Needs or Medical Alerts

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Name

Gender

Age

Tribe

Childcare

Shirt Size

Any Special Needs or Medical Alerts

Participant Media Release Form

I hereby grant permission for video recordings and digital photographs to be taken of myself and/or my child or my child’s work as part of his/her participation in the Ho-Chunk Nation Family Healing Camp held at the Andrew Jackson Powwow Grounds, August 6-8, 2024. I understand that the recordings and images collected may be used by the Ho-Chunk Nation. I authorize the Ho-Chunk Nation to copy. Edit, enhance, crop, or otherwise alter any photo or video in their publications. I waive any rights for approval of any uses. I understand and agree that any photos or videos are the property of the Ho-Chunk Nation. I grant the Ho-Chunk Nation a non-revocable, perpetual, royalty-free license to reproduce any pictures taken of my child’s work. I further release and relieve Ho-Chunk Nation, its elected officials, employees, and other representatives from any liabilities, known or unknown, arising out of the use of this material. I am signing this on behalf of myself and my minor child(ren).

HO-CHUNK NATION Family Healing Camp Release of Liability Site: Andrew Blackhawk Pow Wow grounds August 6-8, 2024

It is understood that unforeseen circumstances may occur during the activities for which the Ho-Chunk Nation, the Department of Social Services or Event Facilitators will not be held responsible. I agree to hold harmless the Ho-Chunk Nation, the Department of Social Services and the Event Facilitators with regard to any risks that I may be exposed to as a result of my participation in the Family Culture Healing Camp. I also understand that by signing this document I am releasing the said agencies and representatives from liability of loss or theft or damages to personal property. I also agree that by signing this document I am releasing the said agencies and representatives from liability for personal injury and agree to hold them harmless in connection with any action or proceeding arising from my participation in the event. I also agree to hold harmless the Ho-Chunk Nation, the Department of Social Services and Event Facilitators for the acts of other participants, vendors and/or community members. Nothing contained herein shall be construed as a waiver of sovereign immunity. Furthermore, I understand that I must abide by all safety protocols regarding COVID-19. Be it therefore resolved that I, the undersigned, agree to the conditions listed above and understand said agreement.