2026 Agricultural
Youth Camp Application

2026 Agricultural Youth Camp Application

Explore - Learn - Grow

Please complete all required sections of this online application. Do not leave required fields blank. If a question does not apply, enter N/A.

Application Deadline: Friday, May 22, 2026 at 5:00 PM.

Camp Dates: Sunday, June 14, 2026 - Friday, June 19, 2026

Student Information

Student Name

Date of Birth

Gender

MaleFemalePrefer not to answer

Mailing Address

City

State

Zip Code

Phone Number

Alternate Phone Number

Email Address

Have you attended the camp before?

YesNo

Tribal Affiliation

How did you hear about the camp?

Primary Language Spoken in Your Home

School Information

School Name

School District

School Address

City

State

Zip Code

Grade Level in Fall 2026

Parent Information

Mother's Name

Father's Name

Mailing Address

City

State

Zip Code

Phone Number

Alternate Phone Number

Employer Name

Work Phone

Other Contact

Emergency Contacts

Name

Relation

Phone Number

Name

Relation

Phone Number

Photo Release

I give permission to Diné College Land Grant Office to use any photographs, images, videos, and/or statements that may be taken during the course of the program for marketing and/or promotional purposes.

I give permission for photo/video/statement use.
Parent/Guardian Initials

Transportation Needs

Do you need transportation to camp?

YesNoNot Sure
If yes, list nearest community for pick-up

Medical Information

A medical provider may need this form before treating a minor’s illness or injury. This information should accompany the student when seeking medical treatment.

Name of Participant

Date of Birth

Name of Parent or Legal Guardian

Mailing Address

City

State

Zip Code

Employer Name

Work Phone

Other Numbers

Medical Details

Does the student have any medical conditions or allergies?

YesNo
If yes, please explain

Any ongoing medical or emotional concerns that may require special attention

Has the student had any major illness during the past year? If so, please explain.

Date of last tetanus shot

Are contacts or glasses worn?

YesNo

Allergies to any medication

Does the student take any prescribed or over-the-counter medications? If so, what are they?

Primary Care Physician's Name

Address

Phone

Dietary Restrictions

The Agriculture Youth Camp will make reasonable efforts to accommodate participants’ dietary restrictions, food allergies, and cultural or medical dietary needs. Parents/guardians are responsible for clearly listing all dietary restrictions and allergies below.

Dietary Restrictions, Food Allergies, or Cultural/Medical Dietary Needs

While camp staff will take precautions to support these needs, the camp cannot guarantee an allergen-free environment. Parents/guardians should communicate any severe or life-threatening allergies and provide necessary medications, such as epinephrine auto-injectors, along with instructions for use.

Student Essay Questions

There are 2 questions. Make sure to answer both. (200-250 words & Responses will be evaluated based on age-appropriate effort and expression.)

Student's Name

1. Interest and Experience

Tell us how you have been involved or interested in agriculture, food, animals, or farming. This could include helping your family, school activities, or things you’ve learned at home or in your community.

2. Community Impact

How do you plan to incorporate your newfound knowledge learned during this camp into your family and community?

Parent/Guardian Consent

Please read thoroughly before submitting this application.

I hereby give permission for my child to attend the Agriculture Youth Camp in Tsaile, Arizona. I understand that the camp will be conducted in person and acknowledge the potential health risks, including those associated with COVID-19.

I understand that room and board will be provided at the Diné College campus dormitory or at a designated camping site. Land Grant staff and educational mentors will serve as chaperones and provide 24-hour supervision during camp activities.

I understand that my child is required to comply with all Agriculture Youth Camp rules and regulations, as well as all applicable Federal, State, and Tribal laws. I acknowledge that Diné College camp personnel are mandated reporters and are required to report any suspected child abuse to the appropriate authorities.

I understand that my child may participate in off-campus activities and that supervision will be provided during all planned activities. I understand that Diné College Land Grant Office and camp providers are not responsible for accidents, injuries, or other incidents resulting from a participant’s failure to follow established rules, regulations, or policies.

If my child leaves the camp voluntarily before the scheduled end date, I understand that they will be released only into the custody of a parent or legal guardian. The camp reserves the right to dismiss a participant at any time for violation of camp rules or policies.

I understand that participation in camp activities involves inherent risks, which may result in minor or serious injury. I agree that the Agriculture Camp providers shall not be held liable for any injury or loss of personal property arising from participation in camp activities.

I have read and agree to the parent/guardian consent statement above.

Student's Name

Parent/Legal Guardian's Name

Date

Final Confirmation

By submitting this online application, I confirm that all information provided is true and accurate.

I confirm that all information provided in this application is true and accurate.

2026 Agricultural
Youth Camp Application