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Independent Living Youth Conference 2009 WHO: New Mexico Foster youth ages 16-21 WHEN: August 3-5, 2009 WHERE: Sagebrush Inn-Taos, NM WHAT: Life Skills Workshops, Swimming, Dancing, Art, Hip Hop, National Speakers & Socializing This is a FREE event that will offer lots of fun, socializing, meals, door prizes, T-shirt and a bag full of gifts! COME JOIN US! Agenda Monday, August 3rd: 1:00-3:00 p.m. 3:15-3:30 p.m. 3:30-5:15 p.m. 5:15-5:30 p.m. 5:30-6:30 p.m. 6:30-7:30 p.m. 7:30-7:45 p.m. 8:00-9:30 p.m. 9:30-10:30 p.m. 10:30-10:45 p.m. 11:00 p.m. Registration – Sagebrush Inn Review of Conference Expectations Relax, Swim and Unpack Check in with Chaperones Dinner Foster Club Check in with Chaperones Opening Speaker Hip Hop Check in with Chaperones Lights out Tuesday, August 4th: 8:00-9:00 a.m. 9:00-9:15 a.m. 9:30-10:30 a.m. 10:30-10:45 a.m. 10:45-11:45 a.m. 11:45-12:00 p.m. 12:00-12:45 p.m. 12:45-1:00 p.m. 1:00-2:00 p.m. 2:00-2:15 p.m. 2:30-3:30 p.m. 2:30-3:30 3:30-5:30 p.m. 5:30-5:45 p.m. 6:00-6:45 p.m. 7:00-8:oo p.m. 8:00-8:15 p.m. 8:15- 10:30 p.m. 10:30-11:30 p.m. 11:30-11:45 p.m. 12:00 a.m. Breakfast Check in with Chaperones Workshops Break & Snacks Workshops Break Lunch Check in with Chaperones Workshops Break Workshops Taos Pueblo Swim, Video Games or Karaoke Check in with Chaperones Dinner Relationship Building Check in with Chaperones Dance discussion & Dance Karaoke Check in with Chaperones Lights Out Wednesday, August 5th: 8:00-8:45 a.m. 8:45-9:00 a.m. 9:00-10:00 a.m. 10:00 a.m. Breakfast Check in with Chaperones Closing Speaker-Mark Anthony???? Sack Lunch and Farewell Rules & Expectations Please read, initial each item and sign your name stating you agree with the rules and will honor them. __ 1. I will not sneak out of my room at night. __ 2. I will not allow any outside guests or visitors in my room. I understand that youth of the opposite sex are not allowed in my room without staff present. __ 3. I will not switch my rooms without first getting permission from CYFD staff/chaperone. __ 4. I will not bring or use alcohol, drugs, fireworks, firearms, pocket knives, or weapons of any kind. If I see anyone breaking this rule, I will report it immediately. __ 5. I will be responsible for all my personal property. __ 6. I will respect others’ personal property and personal space, which means I will keep my hands to myself. __ 7. I will not leave the conference site for any reason unless it cleared and coordinated with staff in advance and I have CYFD staff with me. __ 8. I will be respectful of others and treat others how I would like to be treated. __ 9. I will not kiss, engage in other public displays of personal affection, or have any kind of sexual activity with others during the conference. __ 10. I will wear appropriate clothing. __ 11. I will not get physically or verbally violent. __ 12. I will respect the speakers while they are presenting. __ 13. If I break any of the above stated rules, I understand that I may be excluded from the remainder of the activities and may be required to leave early. 14. I will let my youth services consultant know if I am on medication. Youth Signature Date Independent Living Youth Conference 2009 Application PLEASE PRINT Gender: □ Female □ Male Name: ______________________________ Address: _______________________________________________________________ Phone: __________________Email: ____________________Birth Date: _______________ Name of Person You’d Like to Room with at the Conference:_______________________ (It’s okay to not put anyone down. We will match you with the right peer!) Please indicate T-shirt Size: (Adult Sizes) _ Small _ Medium _ Large _ X-Large _ XX-Large _ XXX-Large (Please give full name and contact phone number) Foster Parent/Caregiver: ___________________ Phone Number: __________________ CYFD Social Worker: ______________________ Phone Number: __________________ Youth Services Consultant: _________________ Phone Number: __________________ Probation Officer: _________________________ Phone Number: __________________ TRANSPORTATION (talk to your Youth Services Consultant if you need transportation) My transportation to and from the conference will be provided by : ____________________________ MEDICAL INFORMATION Please attach a copy of your Medicaid Card Medicaid Plan: ____________________ Medicaid ID Number: _______________ Medication: □ Yes □ No Type/Name and Dosage:______________________________ Special Medical Needs: □ Allergy □ Epilepsy □ Heart □ Pregnant □ Diabetes □ Handicap □ Insect Bites □ Other: Special Dietary Needs: ______________________________________________ Please describe any of the above or additional special needs on a separate sheet of paper & submit with this application PLEASE SIGN & DATE I have read and understood and agree to abide by the Rules & Expectations. ________________________ _________________ Youth Signature MAIL New Mexico State University School of Social Work ATTN: Gloria Nuñez P.O. Box 30001/MSC 3SW Las Cruces, NM 88003-8001 You may mail or fax to: Date FAX ATTN: Gloria Nuñez (575) 646-4116 DEADLINE to submit applications is July 15