Home - City of Tacoma
Name:Address: Email Address:Phone NumberCurrent Academic Year:?Freshman ?Sophomore ?Junior ?Senior High School InformationPlease select your High School:?Henry Foss?Stadium?Wilson ?Lincoln ?Mount Tahoma?Oakland?iDEA?SOTA?SAMI ?Willie Stuart Academy?Annie Wright?Other____________________________Demographic Information (The following demographic information is voluntary, but would assist us in meeting our goals for this program. All information provided will be held privately.)Age: Gender: Ethnicity (Check all that apply)?African American / Black?Caucasian / White?Native American / Alaskan Native?Asian / Pacific Islander?Hispanic / Latino?Other_________________QuestionnaireAre you considering pursuing a career in local government??Yes ?No?UnsurePlease explain why you would like to participate in Student Government Day?List one issue or topic important to you that you think the City Council should address.If you were the Mayor of Tacoma, what is one thing you would change and why? Parental Consent Form and Media ReleaseThank you for your interest in participating in the City of Tacoma’s Student Government Day on December 10, 2019. Participation may include among other things: spending time in or about City of Tacoma facilities or work sites with City of Tacoma staff, learning about how municipal governments operate and about issues facing the City of Tacoma.PARENTAL CONSENTStudents will be provided transportation by Tacoma Public Schools from the students’ respective High Schools to the Tacoma Municipal Building if the student attends a Tacoma Public School. Bus vouchers will be made available to any student needing to use public transportation to return to their place of residence. Please check this box if your student will need a bus voucher.?Yes?No I understand that this Waiver of Liability Agreement (Waiver) and Parent/Guardian Consent form must be signed by me, or a parent/guardian if I am under 18 years of age, in order to participate in the Student Government Day event sponsored by the City of Tacoma. As a Parent/Legal Guardian I, __________________________________ , hereby grant my permission for the above named minor child) to participate as a volunteer for the City of Tacoma. I acknowledge, agree and understand that said participation may involve risks and inherent dangers that may cause injury and/or death. On behalf of myself and the minor above, I agree to assume the liability and obligations referenced above and to release and hold harmless the City of Tacoma and its agents, representatives, and employees of and from all claims, demands, actions, caused of actions, suits, damages, losses and expenses, of any and all nature whatsoever which might arise out of the activities associated with the City of Tacoma Student Government Day. (Signature) (Date)MEDIA RELEASEI grant the City of Tacoma permission to photograph, videotape, or quote my child participating in the Student Government Day event and to use said photographs, videotapes, and/or quotes regarding participation in the Student Government Day program for educational and public interest purposes.?Yes ?No Emergency Contact InformationName of Emergency Contact: Phone Number of Emergency Contact:Address of Emergency Contract: Relationship of Emergency Contact to Student: Does the student have any known allergies, physical limitations, or other medical considerations for which we might need to make accommodations: Please fill in the application form and submit it to us in one of the following ways:Scan or take legible photos of the forms and send them to lware@ Give it to your high school’s counseling department to send to us.Drop it by the TacomaFIRST 311 Customer Support Center on the 2nd Floor of the Tacoma Municipal Building on 747 Market Street.Mail it to: Student Government Dayc/o Latasha Ware747 Market St., Room 1200Tacoma, WA 98402For Questions or Comments, please contact:Latasha WareManagement Fellow(253) 591-5274lware@ ................
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