2015 Costa Rica Registration Checklist

Transcription

1 2015 Costa Rica Registration Checklist Complete Online Registration at the link that was ed to you. Online registration system closes at 5:00 p.m. EST on January, 15, Complete the Costa Rica Waiver/Release of Liability These forms are included in this packet and must be postmarked by February 1, 2015 to avoid having your registration cancelled. Requires parent/legal guardian signature. Complete the Costa Rica Personal Conduct Agreement Requires parent/legal guardian signature. Complete the Costa Rica Cancellation Policy Requires parent/legal guardian signature as well as the signature and seal of a Notary Public. This form will not be accepted unless notarized. Complete the Request for Special Needs Accommodation (only if applicable) Requires parent/legal guardian signature. Pay the $300 non-refundable deposit Credit card payments are accepted through the online registration system. If mailing a check must be postmarked by January 15th, /Mail a copy of your signed U.S. Passport to the National FFA Center Passports must be signed on the page opposite the photo ID page. A copy of your passport must be received by April 15, If your passport is not received by this date, your registration will be cancelled and you will still be bound to the terms of the cancellation policy. Do not delay in applying for a passport. Average processing time is 4-6 weeks from door-to-door. These items should be sent to the following address: Madeline Young National FFA Organization 6060 FFA Drive Indianapolis, IN For questions, please contact Madeline Young at myoung@ffa.org or

2 National FFA Organization Waiver, Release of Liability, Consent to Medical Attention, Authorizations and Certifications Name: State: In exchange for my being allowed to participate in the FFA National Proficiency & Stars Travel Seminar - Costa Rica program, a program administered by the National FFA Organization ("FFA"), I, and if I am not 21 years old, my parent or legal guardian (individually and collectively referred to below in the first person singular) agree to be bound by the following: 1. Voluntary Participation. I understand and confirm that my participation in the Program is voluntary. 2. Identification of Risks. I understand that FFA and its representatives may not be present during my participation in the Program. I understand that my participation in the Program may involve risk of injury and loss, both to person and to property. I also understand that the risk of injury may include the possibility of permanent disability and death. 3. Assumption of Risk. I assume all risks, known and unknown, foreseeable and unforeseeable, in any way connected with my participation in the Program. I accept personal responsibility for any liability, injury, loss or damage in any way connected with my participation in the Program. 4. Release and Waiver. I release FFA and its directors, officers, employees, agents, volunteers, successors, and assigns from any and all liability for and waive any and all claims for injury, loss, or damage, including attorneys' fees, in any way connected with my participation in the Program (a "Claim"), whether or not caused in the whole or part by the negligence of FFA or any of the individuals mentioned above. 5. Consent to Medical Treatment. I authorize FFA to provide to me, through medical personnel of its choice, customary medical assistance, transportation, and emergency medical services. This consent does not impose a duty upon FFA to provide such assistance, transportation, or services. 6. Publication. I authorize FFA to use my name, photo, materials produced for the program, or presentation in program for FFA materials, including but not limited to, educational resources, press releases, web-based publicity, & other publicity materials. 7. Severability. Each term and provision of the instrument shall be valid and enforced separately to the fullest extent permitted by law. 8. Applicable Law. This instrument shall be governed, construed, and enforced in accordance with the law of the State of Indiana. 9. Participant's certification of eligibility and original effort, and authorization to use materials: a. I hereby certify that I meet all eligibility requirements for participation in the above cited FFA program for the current year, as set forth by the National FFA Constitution. b. Any material submitted is the result of my own effort and ability. However, in securing information as direct quotes or phrases, specific dates, figures or other materials, such must be marked in "quotes" in manuscripts and are identified in the bibliography at the end of the manuscript. Failure to do so represents plagiarism and will automatically disqualify a contestant. (Action of Boards of National Officers and Directors, October, 1960.) THIS IS A WAIVER AND RELEASE OF LIABILITY. I HAVE READ THIS WAIVER, RELEASE OF LIABILITY AND CONSENT. I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT. I AM SIGNING THIS WAIVER, RELEASE OF LIABILITY AND CONSENT VOLUNTARILY. Participant: Printed Name Signature Date If the person participating in the program is not yet 21 years old, both parents or the legal guardian(s) must sign: In exchange for my/our child or ward being allowed to participate in the Program, and as the parent(s) or legal guardian(s) of the abovenamed individual, I/we verify that I/we fully understand, agree to, and accept all provisions of this Waiver, Release, of Liability and Consent. Guardian: Printed Name Signature Date Guardian: Printed Name Signature Date

3 NATIONAL FFA ORGANIZATION PERSONAL CONDUCT AGREEMENT - GLOBAL Proficiency & Stars Travel Seminar - Costa Rica While participating in the above mentioned program, managed by National FFA Organization ("FFA"), you not only represent FFA but also the United States of America. FFA has, therefore, established certain behavioral expectations that must be observed by all participants to maintain good standing with FFA and participation in these programs. All participants in an event or activity sponsored by FFA are prohibited from involvement in unsafe, irresponsible, and/or illegal conduct. You are prohibited from consuming alcoholic beverages, using illegal drugs and tobacco. In addition, you must abide by all rules and regulations established by FFA for participation in this program. (a) I promise that my attitude, conduct and appearance will be such to reflect credit on my chapter, school, community, state FFA association and National FFA Organization. I promise to abide by the National FFA Code of Ethics and any appropriate FFA dress codes. (b) As a representative of more than 540,000 FFA members, I will be well groomed and dressed appropriately during the program. (c) I will not possess or use drugs, alcohol or tobacco at any time during the conference. I understand if I violate this rule, I will be sent home immediately and will assume responsibility for all expenses involved, and my state advisor(s) and parent(s) / guardian(s) will be notified. I agree to allow FFA and its representatives to make reasonable, unannounced searches of my living quarters and personal belongings if FFA reasonably suspects that I am violating the behavioral expectations set forth in this agreement and other applicable FFA publications. A full-time National FFA employee will also be present for any search of property. (d) I will pay for all personal costs and any damage of hotel property directly to the hotel before I depart. FFA reserves the right to immediately terminate from this program anyone who is found to have violated these behavioral expectations. Students terminated from the program will be sent home at their own expense and will be responsible for all other expenses associated with their termination. I will not be entitled to any refund of money I have paid to FFA for my participation in the program. Booking travel will remain the responsibility of National FFA staff. Parent(s) or guardian(s) will provide National FFA staff with necessary information to book travel. Participants terminated from the program and under the age of 18 will be required to purchase airline assistance for unaccompanied minors unless chaperoned by an advisor, parent or guardian. By signature below, I acknowledge that I have read this Personal Conduct Agreement, understand the behavioral expectations of this program, agree to abide by those behavioral expectations, and agree to each of the above paragraphs. Printed Name (Participant) Signature Date If the participant is not 21 years of age, the parent(s) or legal guardian(s) of the participant must sign below. In exchange for my child or ward being allowed to participate in this global travel program sponsored by National FFA Organization and as the custodial parent(s) or legal guardian(s) of the above-named individual, I/we verify that I/we fully understand, agree to, and accept all provisions and obligations set forth in this Personal Conduct Agreement. Printed Name (Parent or Legal Guardian) Signature Date

4 FFA Global Programs Cancellation Policy Submitting this application indicates your intent to participate in an FFA Global Program. This application also indicates that you have received permission to leave the United States from your parent or legal guardian if you are under 18 years of age. If you cancel your participation in an FFA Global Program for any reason, including an inability to raise funds, inability to obtain a passport by the deadline of April 15, 2014 or because you simply changed your mind about traveling, the following guidelines apply: 1. Regardless of the date that you cancel your program, the deposit of $300 is forfeited. 2. Cancellation between 31 and 60 days (including the 31st and 60th day) will result in a cancellation fee of 50% of the program costs unless a substitute traveler is named by the state association. 3. For cancellation within the 30-day period (including the 30th day) prior to departure, the entire program cost will be charged unless a substitute traveler is named by the state association. Additional airline charges for name change on the ticket or room charge depending on gender may be applicable. NOTE: Any and all cancellations must be received by the National FFA Organization in written form. The date this written notification is received will be used to determine the cancellation date. It is the participant's responsibility to ensure that the cancellation notice was received by the National FFA Organization. Approximate program costs vary due to flight costs, currency exchange rates, and time of year. However, most seminars range from $3,000 to $3,500. I have read and understand the terms of this cancellation policy for FFA Global Programs. My signature below signifies that I agree to abide by this policy. (A Notary Public must witness the signing of this form) Participant's Printed Name Participant's Signature Date Parent/Guardian Printed Name Parent/Guardian Signature Date Subscribed and sworn to me this day of Notary Public Signature Cancellation Proficiency & Stars Travel Seminar Application Application National FFA Organization Page 1 of 1

5 FFA Global Programs SIGNATURES AND MEDICAL RELEASE By completing and signing this application, I am expressing my intent to participate in an international program under the direction of the National FFA Organization. I agree to pay, in full, the deposit associated with this program. I agree to pay these costs prior to departure. By applying for this program I hereby release National FFA to use any pictures, video, quotes and information provided in promotional materials including, but not limited to, websites, printed materials, reports, and other documents. We certify that all information in this application is true, correct, and complete to the best of our knowledge. ALL SIGNATURES ARE REQUIRED. Signature of Applicant Date Signature of parent or legal guardian Date Advisor's Signature Date OVER-THE-COUNTER DRUG RELEASE I grant the National FFA Organization permission to administer the following Over-The-Counter drugs to the participant (check all that apply). Acetaminophen Benadryl _ (Tylenol) Ibuprofen Tums/Rolaids/Pepto Bismol Asprin Dramamine (motion sickness) MEDICAL RELEASE I hereby authorize the National FFA Organization to make any and all determinations as to emergency medical treatment which I may need during the time I am participating in FFA Global Programs, provided that every effort is made to notify my emergency contact of such treatment within twenty-four (24) hours. "Emergency Medical Treatment" shall be defined as any life-threatening medical or surgical procedure which a reasonable an prudent person would deem to be necessary within a reasonable period of time, or in such cases where the National FFA Organization is unable to locate me to obtain my consent. I hereby waive and release the National FFA Organization from any liability for any medical attention or any other medical related charges in connection with my participation in FFA Global Programs. Signature of Applicant Signature of Parent/Legal Guardian You will not be allowed to participate in this program without this form being on file.

6 Request for Special Needs Accommodation for National FFA Noncompetitive Activities Deadline: Must be submitted by February 1, This form is to request accommodations for non-competitive National FFA activities. Please be advised if this form is not received by the deadline, National FFA cannot guarantee that accommodations will be provided. **You only need to complete this form if you are requesting special accommodations** The following information is required if there is a FFA member or adult that plans to participate in a National FFA noncompetitive activity and wishes to request an accommodation for a disability. Please complete the following information, print the completed form and secure necessary signatures. Please mail, scan and or fax the signed form to Jim Armbruster by February 1, Electronic signatures cannot be accepted. Jim Armbruster Senior Partner Services Specialist National FFA Organization P.O. Box FFA Drive Indianapolis, IN jarmbruster@ffa.org (Office) (Fax) This information will be kept strictly confidential and will be used only to process services for participants needing special needs assistance. National FFA may request further documentation on the participant s disability upon receipt of this application. Name of FFA activity attending: Name of participant needing accommodations: Parent/Guardian Name, if participant is under 21 years of age: Home Address: Participant Telephone Number: Chapter Name: Chapter Number: Advisor s Name: Advisor s Phone Number: Advisor s Description of Disability and Accommodations Requested Specific Disability: Please describe the limiting nature of the disability and the accommodations requested: Please list accommodation or accommodations provided at local or state level for this participant: Student Signature/Date Parent Signature/Date Advisor Signature/Date Authorized State Staff/Date This is only an application for special needs assistance. If additional information is needed the advisor or the participant s parents will be contacted for additional information.