Chahta Alla Youth Council Membership Application

Home $ Chahta Alla Youth Council Membership Application

Name *

Date of Birth *

Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Age *

Parent Phone Number *

Participant Phone Number *

Email *

T-Shirt Size

Gender *

Community *

School *

Grade *

Family Information

Mother/Guardian Name *

Phone Number *

Work Number *

Email *

Father/Guardian Name *

Phone Number *

Work Number *

Email *

Emergency Contact Information

Name (Emergency Contact #1)

Relation to Child

Phone Number

Work Number

Name (Emergency Contact #2)

Relation to Child

Phone Number

Work Number

The purpose of the Chahta Alla Youth Council are to strengthen family values, promote understanding of and building a strong tribal government with community participation, preserve tribal culture and traditions, help to solve social and economic issues facing the community and encouraging others to do the same. Provide service to community who have special needs, build self-esteem, expand skill levels and communications, and promote a healthy environment.

I would like to join the Chahta Alla Youth Council because:

Participant Signature

Parent Signature

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