The following are precautionary behavioral standards & assurances that comply with the Humboldt County approved re-opening plan for these activities. Participants shall adhere to these standards while participating in the Blue Lake Rancheria Tribal Education Agency’s Kindling the Flame: A Youth Cultural Revitalization Program activities facilitated by CA State Parks Interpreters at Sumeg Village.

As a condition of participation in the Youth Cultural Revitalization Program, I agree to the following Covid-19 precautionary behaviors. I will:

• Answer all the following questions at the beginning of each session:
  • Have you come into contact with anyone with a suspected or confirmed Covid-19 case in the last 14 days?
  • Have you or anyone you live with experienced any symptoms including cough, fever, difficulty breathing, or other signs of illness within the last 24 hours?
  • Have you taken any fever reducing medication in the last 24 hours?

• Exclude myself from activities if I have a temperature of 100.4F, or am experiencing any symptoms of illness, notifying the Program leaders by phone, text, or email that I will not be attending prior to the session’s start time; and

• Keep six (6) feet of separation between myself and others at all times while at Sumeg Village and participating in this program, and not engage in horseplay or any potential actions that could infringe upon the six (6) foot separation; and

• Wear a mask at all times while participating in this program and its activities, removing it briefly only to eat or drink. My mask will be in place prior to approaching the gathering area at the beginning of each session and will remain in place until I have left; and

• Wash my hands or use hand sanitizer before arriving at Sumeg Village, or immediately following arrival at a provided sanitizing station, and will sanitize my hands before and after touching any pre-packaged food/snacks, water bottles, eating, and using the restroom facilities; and

• Sneeze or cough into my shoulder or elbow, not my hands, even when wearing a mask, nor will I cause bodily fluids to be disbursed (no spitting, kissing, licking, etc.); and

• Use precautionary actions, such as using a tissue when using the handle to flush the toilet, and wash my hands for 20 seconds using soap after using the restroom, using single use paper towels to dry my hands thoroughly; and

• Label my personal items (i.e. composition books and pencils), keep them separate from others personal items, and not touch or handle other persons’ personal items.

Blue Lake Rancheria Tribal Education Agency
Youth Cultural Revitalization Program
Medical Release & Consent to Treat
Consent to Treat

In the event of illness or injury during my student’s participation in the Youth Cultural Revitalization Program, I do hereby consent to whatever X-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care that are considered necessary in the best judgement of the attending physicians or dentist and performed by or under the supervision of a member of the medical staff of the hospital or facility furnishing medical or dental services.

OR