Please select the option that best describes the location of your community: (Required) Address
(Required) Purpose: Water Issues Impacting Indigenous Peoples & Solution-Oriented Responses
The purpose of these questions is to learn about what participants hope to gain at the MKW Summit, and how Indigenous Peoples are responding to water issues. The responses to the following questions will be synthesized into MKW reports, social media content, programmatic work, and used for other media and content development purposes. This can include but is not limited to presentations, research, improving MKW programming, and development of workshops, trainings, and educational materials for local to international dissemination. Responses to questions are anonymous (no names will be used in the public dissemination of the data; only information such as geographic regions, general distinctions like “Indigenous Peoples” or “youth,” and similar information will be used), optional, and you can choose not to answer them. By completing the questions, you agree to hold harmless, and release Mni Ki Wakan, “MKW,” its employees, staff, consultants, and organizers from any and all liability claims, authorizing them (“MKW”) to utilize the data for the aforementioned purposes including and not limited to any other related purpose mentioned in this form.
EMERGENCY CONTACT Emergency Contact Name (Required)
The emergency contact is an adult who can respond expediently and diligently in the case of an emergency.
(Required) PARENT/GUARDIAN/AUTHORIZER: YOUTH REGISTRANT (UNDER 18) TERMS & CONDITIONS
An adult must complete this form if the registrant (s) is under 18 years of age, and register separately. Youth under 18 years of age must be accompanied by an adult at all times. Organizations, programs, parents, or guardians assume full responsibility and liability for youth registrant (s) under the age of 18. By signing and registering a youth (s) under 18 years of age, you are verifying that you have obtained parental/guardian consent and the documentation to do so. The authorizer, parent, or guardian is solely responsible for the youth registrant and all associated responsibilities.
By signing my/our signature, date, we agree to and fully understand the terms and conditions of this agreement provided hereto, are 21 years of age or older, and have obtained parental/guardian consent to register the youth registrant (s) and are acting on behalf of the parent/guardian or are the parent/guardian. I/We understand and agree to accompany the youth at all times, and are solely responsible for the supervision, care, and safety of the youth. I/We, being of lawful age, by affixing my/our E-signatures hereto, do hereby agree to indemnify and to hold harmless the Mni Ki Wakan, its officers, employees, elected officials and agents, from and against any and all liability claims, actions, causes of action, demands, rights, damages, cost, loss of service, expenses, any health issues, and compensation for all negligence whether active or passive arising out of or in any way connected or related to the Mni Ki Wakan.
MEDIA RELEASE, LIABILITY WAIVER, AND COVID-19 HEALTH & SAFETY PROTOCOLS Media Release Form I agree to the Terms and Conditions of the Media Release Form.
I hereby grant Mni Ki Wakan, “MKW,” its employees, staff, officers, representatives, and consultants the absolute and irrevocable right and permission, in respect of the photographs and or video taken of me alone or with others, to use, re-use, publish, and republish the same in whole or in part, individually or in conjunction with other photographs or video, and in conjunction with any printed matter, or electronic matter, in any and all media now or hereafter known, and for any purpose whatsoever; and to use my name in conjunction therewith if Mni Ki Wakan so chooses.
I hereby release and discharge Mni Ki Wakan from any and all claims and demands arising out of or in connection with the use of the photographs or video, including without limitation any and all claims for libel or invasion of privacy.
This authorization and release shall also inure to the benefit of the heirs, legal representatives, licensees, and assigns of Mni Ki Wakan.
I am of full age (18) and have the right to contract in my own name. If I am not yet 18 years of age, a parent or guardian has authorized my signature. I have read the foregoing and fully understand the contents. Liability Waiver Form I agree to the Terms and Conditions of the Liability Waiver Form.
I/We the undersigned, being of lawful age, by affixing my/our signatures hereto, or checking the box hereto, do hereby agree to indemnify and to hold harmless the Mni Ki Wakan, “MKW,” its officers, employees, representatives, elected officials, consultants, and agents, from and against any and all liability claims, actions, causes of action, demands, rights, damages, cost, loss of service, expenses, any health issues, and compensation for all negligence whether active or passive arising out of or in any way connected or related to the Mni Ki Wakan Summit to be held on August 16-18.
COVID-19 Health & Safety Protocols I agree to comply with the Mni Ki Wakan COVID-19 Health & Safety Protocols.
The 2023 Mni Ki Wakan Summit will require social distancing and participants to wear masks at all times (except when eating and drinking water). We ask participants to comply with Mni Ki Wakan health and safety protocols, and any applicable Center for Disease Control & Prevention (CDC) and state COVID-19 mandates and guidance that may be more stringent.
If you are feeling sick, have a cough, fever, or other symptoms, please do not attend. Mni Ki Wakan will have a health coordinator to provide masks and hand sanitizer. We will continue to monitor and update safety precautions for the Mni Ki Wakan Summit. NEWSLETTER
Our team is building a Mni KI Wakan Ecosystem where Indigenous Peoples and youth are creating a transformative and sustainable future for water and all life together. We invite you to join our newsletter; receive updates, news, event info, and other relevant information.