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Winter Break Activity

Questions marked with a * are required

Registration

Please fill out the whole form. You will need both the youth/young adult and their parent/guardian to complete this form. You will receive a confirmation email once it is complete. If you do not receive the email, please reach out to Bubba Riggins at bubba@ncidc.org or 707-445-8451 to confirm that we have received your registration.

Thank you for your interest in this activity. We will making beaded bracelets at this workshop.

Our workshop will be held 12/13 and 12/20/25 from 11am - 2pm at the Del Norte Indian Education Center, located at 888 4th St, Crescent City, Ca.

All information provided on the form will be kept confidential and will not be shared with any external parties.

Youth/Young Adult Contact Information

First Name

Last Name

Youth/Young Adult Cell Phone

Email Address

Address Line 1

Address Line 2

City

Zipcode

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