Student Application

If you have any questions or wish to return the form, please contact:
Kym StClair 707-487-9255 ext. 1554
Nieca Wright 707-487-9255 ext. 1558
Or Email to: ace@tolowa.com
Return by mail or drop off at: 16299 Hwy 101 N, Smith River CA. 95567

I hereby grant the Tolowa Dee-ni' Nation (the “Nation”) the right to take, edit, use and reuse photographs, video recordings and audio recordings of myself at any activity, program or function sponsored by the Nation and/or its affiliates. I understand the Nation may use the photographs, video recordings and audio recordings released herein for any governmental purpose, including various educational and/or promotional purposes. Without limitation, the Nation may post such photographs, video recordings and audio recordings to the Nation’s newsletter, website, event flyers and social media platforms including Facebook, Instagram and YouTube.
Further, I hereby release the Nation and its agents and employees from any and all claims, demands and liabilities whatsoever in connection with the grant of rights to the Nation provided herein. I have carefully read this Media Release Form and understand the grant of rights to the Nation contained herein. I sign this form voluntarily and with the intent to be legally bound.