2025 OKYT Student Intake Form

Sponsoring Cooperative

Student Name (EXACTLY AS ON ID)

First NameLast Name

Preferred Name:

Form of ID

Other

Gender

Student Birthdate

Date

Age as of June 13, 2025

Student Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Student Email (MUST BE ACCESSIBLE IN THE SUMMER!)

example@example.com

Student cell Number

Area CodePhone Number

Winner T-shirt Size (thinner material, can run small)

Polo Size

High School Name

Do you have any travel concerns (e.g., fear of flying, motion sickness)?

If yes, please specify

Hobbies, Interests , or Activities:

Is there anything else we should know to ensure your experience is successful?

Parent/Guardian #1 Name

First NameLast Name

Parent/Guardian #1 Email

example@example.com

Parent/Guardian #1 Phone Number

Area CodePhone Number

Relationship to winner

Parent/Guardian #2 Name

First NameLast Name

Parent/Guardian #2 Email

example@example.com

Parent/Guardian #2 Phone Number

Area CodePhone Number

Relationship to winner

I understand a parent/guardian MUST attend the parent/guardian meeting on Friday, June 13 during registration in OKC.

Please sign in the above box.

Students selected and sponsored by Oklahoma’s electric cooperatives are expected to participate in required preparatory activities related to Oklahoma Your Tour and the full duration of the student program, including group travel to and from Washington, D.C. The student experience has a program value of $3,500 per participant. While cancellations are unfortunate, cancellation notifications received/processed 60-days prior to the day of registration are appreciated and needed to allow cooperatives to find alternate student participants. Families of selected students who cancel less than 60-days prior to the day of registration, may be responsible for reimbursing the sponsoring cooperative up to 50% of the program value. No shows and families of selected students failing to notify their sponsoring cooperative of non-participation, may be held responsible for reimbursing 100% of the program value.

Date

Please sign in the above box.

Do you have any allergies (food or medication)?

If yes, please specify:

Do you have any dietary restrictions or special requirements?

If yes, please specify:

Do you have any medical conditions we should be aware of?

If yes, please specify:

Do you take any regular medications?

If yes, please specify:

Front of Insurance Card

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Back of Insurance Card

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I/we, the undersigned parent(s)/guardian(s), desiring that our child shall have the opportunity to visit Washington, D.C., from June 13-19, 2025 sponsored by the Oklahoma Association of Electric Cooperatives, hereby consent to our child taking this trip. We further authorize and direct NRECA and Oklahoma Association of Electric Cooperatives, through their duly assigned directors and chaperones on said trip, to direct and supervise our child.We further request and authorize NRECA and Oklahoma Association of Electric Cooperatives through said directors and chaperones, to secure any medical or other emergency services that they may, in their discretion, believe to be necessary for our child during this trip. For good and valuable consideration, the receipt of which is hereby acknowledged, I hereby consent to the photographing of my minor child and the recording of his/her voice and the use of these photographs and/or recordings singularly or in conjunction with other photographs and/or recordings for advertising, publicity, commercial or other business purposes. I understand that the term “photograph” as used herein encompasses both still photographs and motion picture footage. I further consent to the reproduction and/or authorization by the Oklahoma Association of Electric Cooperatives, Inc. to reproduce and use said photographs and recordings for use in all domestic and foreign markets.The undersigned hereby releases and forever discharges NRECA, Oklahoma Association of Electric Cooperatives, sponsoring distribution cooperatives, their boards, officers and employees from any and all claims, causes of action or liability whether known or unknown, relating to any medical condition existing on the date hereof, which claims, causes of action or liability arise or result from participation in the OAEC Youth Tour. I/We also agree to indemnify and hold harmless those persons of above stated organizations on any claims for damages, liability, injury, expense, or loss arising out of the OAEC Youth Tour.I certify that I have answered the above questions as accurately as possible, and that all known information about this student has been listed accordingly and that I/we have read, understand and acknowledge that I/we are releasing OAEC and from any and all claims, causes of action and liability which may arise as a result of said medical conditions listed or should have been listed.In addition, in case of accident or need for medical attention, I/we give permission to NRECA, Oklahoma Association of Electric Cooperatives, sponsoring distribution cooperatives, their boards, officers and employees to take participant to a doctor and/or medical facility. (It being understood that all expenses for treatment provided will be borne by the parent, guardian, or participant.)It is understood that the Oklahoma Association of Electric Cooperatives, Inc., will purchase at its expense, a life insurance policy (limits and provisions of policy shall prevail) for our child in the amount of $10,000 covering the period of same trip. It is also understood and agreed that by signing this document, we are waiving any and all rights, other than the above-mentioned life insurance policy, to recover damages due to the negligence of the Oklahoma Association of Electric Cooperatives, Inc., its directors, officers and/or agents during the trip to Washington, D.C., from June 13-19, 2025

Signature

Date

2025 Youth Tour Student Intake Form

Student Information

Additional Information

Parent/Guardian Information

Participation Policy

2025 Youth Tour Student Photo/Medical Release Form

Please attach your insurance