Little Traverse Bay Bands of Odawa Indians, Waaniigaanzijik Youth Services Supplementary Education Program Registration Form

When: Monday through Thursday, 3:15PM-5:30PM

Who: Tribal Youth Ages 6-18; LTBB Enrolled, LTBB Descendants or enrolled in another tribe

Where: 525 West Mitchell St., Middle Unit 1A, Petoskey, MI 49770 (across from McLaren Hospital)

Please read the following registration info & questions and sign.

If you have any questions, contact Tina at 231-242-1593 or kdominic@ltbbodawa-nsn.gov.

Processing registration could take up to 2-3 business days to complete. Registration forms are processed in the order received. Caretakers will receive an enrollment confirmation via email once enrollment is complete.

Miigwech!

K-5 Academic Support
Please select from the "yes" or "no" boxes below if you would like to be contacted about K-5 Academic Support.

Our Academic & Cultural Program Specialist Lisa Wells will reach out to you for registration information.

Individualized academic support is only for grades Kindergarten through 5th. All Youth enrolled in YS Supplementary Education Program will have access to group homework support. *

Yes, contact me about K-5 Academic Support

No, thank you

Youth Registration

Please select the days your child will attend: *

Monday

Tuesday

Wednesday

Thursday

Youth Full Name: *

Youth's School: *

Youth's Grade *

Physical Home Address: *

Home Mailing Address (if different from physical home address): *

Youth Birthdate: * +

Youth Gender Pronouns (not required, but helpful):

Youth Tribal Affiliation (LTBB enrolled, LTBB descendant, enrolled in other tribe) - please list Youth's Tribe and Enrollment Number: *

Parent/Guardian Information

Parent/Guardian Name(s): *

Parent Email: *

Parent Texting Phone: *

Parent Work Phone: *

Initial here to give Youth Services permission to use youth photos and videos on LTBB Government website & program materials, Odawa Trails, program flyers, DOJ/OJJDP funding agency & tribal social media pages: *

Initial here to verify that your child's vaccination/booster records are up to date: *

Please note: Waaniigaanzijik Supplementary Education Program generally follows local school calendars. Youth Services closes during LTBB Government Holidays, tribal government emergency closures, school holidays, & school snow days. Youth programming may be canceled at any time, with little or no notice. Cancellations may occur due to weather, staffing, illness, building maintenance, or other unforeseen circumstance.

Health & Safety Protocols

Youth parents/caretakers:

Your consent is required for your child to participate in the LTBB Waaniigaanzijik Youth Services 2024/25 Supplementary Education Program. Please review and sign this section.

Activity Description: YS Supplementary Education Program

Locations: 525 West Mitchell Street, UNIT 1A, Petoskey (across from McLaren Hospital)

Program Dates: Monday, December 9th-December 19th & January 13th-June 5th

The following health and safety protocols will be adhered to:

Youth who fall ill or do not pass illness screening must go home with caretaker immediately
PLEASE KEEP CHILDREN AT HOME UNTIL SYMPTOM FREE & **FULLY** RECOVERED
Emergency mask mandates may be required when community risk level enters yellow or orange (medium to high risk levels)
YS staff are not permitted to administer medications to youth
REMINDER: DISCIPLINARY FORM MUST BE SIGNED & RETURNED TO PROCESS ENROLLMENT
Healthy snacks provided (please send alternate snack if your child has special dietary needs)

PARENT PICK-UP/DROP-OFF INFO:

Drop-off time is between 3:15-3:45PM
Pick-up time is between 5:00-5:30PM
Late drop-offs are not allowed
Parents should remain in vehicle when picking up and leave promptly to keep the pick-up line moving (seatbelts first of course)
For Petoskey Schools bussing information, please call Petoskey Bus Garage at 231-348-0178
Chronic lateness at pick-ups will result in earlier pick-up time or program ineligibility
Disrespectful behavior/language toward Youth staff will result in program ineligibility

Sign here to give consent for your child to participate in the Waaniigaanzijik Youth Services Supplementary Education Program for the 2024/25 school year & agree to program protocols and policies: *

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Date signed: * +

Emergency Contact(s)

In the case that we cannot get a hold of you (parent/caretaker), please list at least 1 EMERGENCY contact that has your permission to pick up your child:

Emergency Contact #1 Name: *

Home Phone Number: *

Work Phone Number: *

Mobile Phone Number: *

Relationship to child: *

Emergency Contact #2 Name:

Home Phone Number:

Work Phone Number:

Mobile Phone Number:

Relationship to child:

Medical Information

So that we can better support your Youth, please list any medications, allergies, medical needs, learning challenges, mental health and/or behavioral conditions or known trauma triggers: *

I give permission for emergency medical treatment upon injury *

Yes

Food or other allergies, please specify: *

Family Doctor/health clinic name & phone number: *

Transportation to LTBB Youth Services

Youth can ride the Petoskey Public Schools shuttle bus #10 to Lincoln Elementary School from Petoskey Middle School. From Lincoln Elementary School, Youth staff will walk Youth over to our new Youth Services building located at 525 West Mitchell St., Middle Unit 1A.
Please register your Youth for shuttle bus 10 by calling the Petoskey Bus Garage at: 231-348-0178.
Parents/Caretakers: please inform your child's school office and teacher that your child plans to ride the shuttle bus #10, from Petoskey Middle School, down to Lincoln Elementary School.
Parents, you are responsible for your child’s arrival at Lincoln Elementary School.
Parents, you are responsible for transporting your child to the Youth Services building if he/she/they miss the shuttle bus #10 to Lincoln Elementary School.
Youth Services Disciplinary Policy will be enacted if Youth do not follow given directions/safety instructions while walking or riding in LTBB Government Vehicles.

BY SIGNING BELOW, I AGREE TO THE ABOVE INSTRUCTIONS/POLICIES AND GIVE PERMISSION FOR YOUTH SERVICES STAFF TO WALK OR TRANSPORT MY CHILD IN A GOVERNMENT VEHICLE, FROM THE LINCOLN ELEMENTARY SCHOOL TO LTBB YOUTH SERVICES BUILDING, LOCATED AT 525 W. MITCHELL ST., PETOSKEY: *

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Date signed: * +

Supplementary Education Program Disciplinary Policy

Zero Tolerance policy for: bullying, threats, weapons, violence, language, or

inappropriate behavior by Youth (or parent): Youth program enrollment will be terminated immediately.

First & Second Daily Warnings:

Youth will be warned verbally if their behavior disrupts Staff or group activity.
Upon 1st & 2nd warning, two Youth Services Staff will be present to explain in a positive manner why the behavior is not allowed. Verbal warnings will be conducted in a respectful and explanatory way.
Parents will receive verbal notification from staff that their child has received verbal warnings.
Warnings and parent notifications will be documented in staff binder.

Third Daily Warning: Upon 3rd incident, Youth will be sent home from program, and parent will receive a written incident report.

Parent must pick up Youth immediately upon contact and notice of incident from Youth Services program staff.

YS programming reserves the right to warn, suspend, or dismiss Youth if:

a Youth receives multiple third incident warnings within a short duration of time and suspension will be determined by Youth Services Director after Staff discussion.
a Youth requires an inordinate amount of attention from staff thereby causing inadequate levels of supervision for the remainder of the group.
Youth behavior poses a danger or threat to themselves, or for any reason within the discretion of YS Staff & YS Director.

We do not anticipate any issues; however, we will strictly follow the abovementioned policies for the safety of all Youth and Staff.

By signing, I acknowledge that I have read, understand, and agree to YS Supplementary Education Program disciplinary policies set by LTBB Youth Services. YOUTH SIGNATURE: *

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Date signed: * +

By signing, I acknowledge that I have read, understand, and agree to YS Supplementary Education Program disciplinary policies set by LTBB Youth Services. PARENT/GUARDIAN SIGNATURE: *

clear

Date signed: * +