STATE LEADERSHIP CONFERENCE

GUIDE

March 5th

-7th

, 2020 Spokane, WA

TABLE OF CONTENTS

I. General Information Page(s)

Overview 1

Tips and Suggestions 1

Important Dates 1-2

Conference Venues 2

II. Registration Information

How to Register 2-3

Registration Fees 3

Payment Information 3

III. Conference Lodging

Requirements 3

Room Rates 3-4

IV. Competitive & Recognition Event Information

Eligibility 4

Recognition Events 4

Competitive Events 4-5

Competitive Event Finalists Process 5

On-Line Test Proctor Information 5

V. Other Events & Opportunities at the Conference

Symposiums and Leadership Workshops 5

Running for State Office 5

Voting Delegates 5

Courtesy Corps 5

Judging Opportunities 5

VI. Conference Procedures

Participant Forms 6

Conference Dress Code 6

Where to Submit Materials and/or Direct Questions 6

VII. General Reminders

Code of Conduct and Curfew 6

On-Site Chaperoning 6

Appreciation for SLC Staff, Judges and Volunteers 7

Publicity 7

Students with Disabilities 7

Event Managers 7

VIII. International Leadership Conference 7

IX. Conference Forms (also available at wahosa.org)

Test Proctor Confidentiality Agreement Form 8

Advisor On-Line Testing Agreement Form 9

Student Delegate Medical Liability Release Form 10

Student Delegate Code of Conduct 11

Advisor/Chaperone/Guest Medical Liability Release Form 12

Statement of Assurance Form 13

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GENERAL INFORMATION Conference Overview The Washington State HOSA Board of Directors, state staff, and state officers invite you to the Washington HOSA State Leadership Conference!

During the conference, members will have the opportunity to:

• Test their knowledge, skills, and abilities in a variety of health and leadership competitive events!

• Compete for the opportunity to advance to the International Leadership Conference!

• Attend workshops and symposiums on leadership, college/career readiness, and health care!

• Earn recognition in HOSA’s recognition events! • Attend exciting general sessions and hear from professional speakers!

• Run for state office and elect state leaders! • Meet and network with fellow members, advisors, and industry leaders!

Tips and Suggestions • Read this handbook in its entirety! Consider having your chapter officers do the same so multiple members of your

chapter are familiar with SLC requirements and procedures.

• Read the HOSA Competitive Event Guidelines available at hosa.org. Assign your competitor extra credit for reading this and appointing a fellow chapter member to be their “buddy,” in order to have multiple members familiar with their event.

• Follow-up with your district and school business office personnel to make sure the fees will be paid on time.

• Photocopy all forms and correspondence for your records and bring them with you to the conference.

• It is highly suggested that you register your chapter’s members before winter break, so you are ready to register those attending State Leadership Conference.

• Verify all members’ names are spelled correctly. This will be the name on their conference badges.

• Registration payment for State Leadership Conference should be made and sent to Washington HOSA, NOT National HOSA:

Washington HOSA

PO Box 2733

Redmond, WA 98073

• Carefully review HOSA Dress Code Policy and Student Conduct Code standards with your students before you arrive at the conference to ensure students bring appropriate clothing and conduct themselves professionally.

• E-mail questions to office@wahosa.org

Important Dates August – Present

• Affiliate chapter members in the National HOSA on-line system and submit fees in order to be eligible for the State Leadership Conference

• Prepare for competitive events; event guidelines found at http://www.hosa.org/guidelines

January 4th – 17

th

• State Leadership Conference Registration Opens - Conference registration link: http://www.hosa.org/hosaconf/ - All attendees must be registered and dues paying HOSA members prior to registering for conferences

• On-line Test Proctor Registration Opens January 17

th

• Conference Registration Closes • Hotel Room Reservations Due

- Chapter must stay at an eligible conference hotel - Room reservation form is posted at www.wahosa.org and should be sent to office@wahosa.org

• On-line Test Proctor Registration Deadline and Forms Due

- Confidentiality forms can be found at the end of this guide and on wahosa.org - Proctor passwords will not be sent until confidentiality forms are sent to office@wahosa.org

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• State Officer Candidate Documents and Application Due

- Uploaded to Tallo and emailed to Andy Goss, State Leadership Advisor at agoss@wahosa.org February 1

st

• On-line Testing Window Opens

February 7th

• Last Day of On-line Testing • Tallo Upload Window Closes

March 1st

• Conference Payment Due

- Payment should be made to Washington HOSA, not National HOSA March 4

th

• Round 2 Competitors Announced (for applicable competitive events only)

March 5-7th

• Washington HOSA State Leadership Conference

March 20th

• International Leadership Conference Intent to Compete Deadline

May 1st

• International Leadership Conference Registration Deadline - All membership and state conference invoices MUST be paid prior to registering for the ILC

June 24-27th

• International Leadership Conference—Houston, TX

Conference Venues Opening & Closing Sessions and Competitive Events:

Spokane Convention Center

334 W Spokane Falls Blvd

Spokane, WA 99201

Conference Headquarters:

The Davenport Grand

333 W Spokane Falls Blvd

Spokane, WA 99201

(509) 458-3330

REGISTRATION INFORMATION All chapters register for the State Leadership Conference via HOSA’s online registration system. The system is tied directly to HOSA’s affiliation system, so make sure all students and advisors are affiliated with National HOSA before you begin to register for the State Leadership Conference.

Before you begin the online registration process, be sure you have the following information available:

• All student names and competitive event selections

• T-shirt sizes for all registered members, advisors and chaperones/guests

• The names of two or more members to serve on the Courtesy Corp

• The names of two voting delegates (each chapter, regardless of size, is eligible for the same number of voting delegates)

How to Register ONLY ADVISORS MAY REGISTER ATTENDEES. Chapter officers and/or students should not have advisor passwords or access to the registration system. This is grounds for chapter disqualification.

To register for the SLC, please follow these steps (instructions also available at wahosa.org):

• Go to www.hosa.org/hosaconf/

• Log In as a Local Chapter Advisor using your affiliation login and password.

- If you do not know your login or password, please contact the national office.

Registration Window—January 4-17, 2020

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- Verify all student names are spelled correctly and as they would appear on the photo ID they will need to present at all HOSA conferences.

• Select Conference Registration.

- You may be asked for your login and password again.

• Read the conference registration instructions carefully. • On the top left-hand side of the screen:

- Select the dropdown “Select a Conference” - Chose the conference “2020 State Leadership Conference” - Click “Begin Registration”

• Select the name of your first participant and select register:

- Indicate whether the participant is Male/Female.

- Indicate whether the participant is Middle School/Secondary/Post- Secondary/Advisor.

• Advance to activities/options and select the activities for that student. • Go to events and select the competitive events in which the student will participate.

- Students may compete in three (3) competitive event and all recognition events

• Students may participate in as many recognition events they wish.

• In the team number please indicate the team number for team events:

- Team numbers apply only to the specific event—so you may have a Team #1 in CPR/First Aid and another Team #1 in HOSA Bowl.

• After the registration for this student is complete, click “Submit”.

• Continue to register all SLC participants in the same manner.

• Also register advisors, chaperones, and guests. • After completing registration, print your invoice by selecting the icon in the lower left hand corner of the registration

system webpage.

Registration Fees Registrant Staying in Conference Hotel

Students and Advisors $99 per person

Chaperones and Guests $99 per person

No refunds will be granted after January 31, 2020.

Chapters may substitute participants prior to February 1st. Substitutes must have already been registered by the January 17th deadline and must be within the three event rule.

There will be absolutely NO on-site changes for competitive events at the conference.

Payment Information Payment should be made to Washington HOSA and must be received by March 1, 2020. Please work with your school’s bookkeeper to ensure payment will be received by the correct date. Send payments with printed invoice to: Washington HOSA PO Box 2733 Redmond, WA 98073.

CONFERENCE LODGING Requirements The Davenport Grand Hotel is the official conference headquarter hotel for the State Leadership Conference. All attendees traveling into the area, and in need of lodging, must stay at the Grand Hotel or other Washington HOSA designated hotel should additional overflow accommodations be needed.

Local chapters may be exempt from staying in the hotel by providing additional judges and event personnel for the conference.

Room Rates Room Type Single Double Triple Quad

Single King $134.00 $134.00 - -

Double King $134.00 $134.00 $134.00 $134.00

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Hotel tax (Currently 12%) and $2 Tourism fees will be added to the cost of the rooms for a total of approximately $152.08 per night.

To reserve your rooms, submit the hotel room reservation form found at wahosa.org to office@wahosa.org. Only those registered for the conference will be allowed to reserve hotel rooms.

The cut-off date for making reservations is February 7th, 2020. Reservation requests received after this date may be accepted on a space available basis and may not be at the Washington HOSA rate.

Any hotel cancellations after February 1, 2020 are subject to an attrition surcharge of $150 per room night for any nights cancelled exceeding 10% of registered room nights for the chapter. This surcharge must be paid prior to ILC registration or ILC registration may be blocked.

COMPETITIVE AND RECOGNITION EVENT INFORMATION Eligibility Students must be affiliated and paid members to compete at the State Leadership Conference. Students can compete in three (3) competitive events at the State Leadership Conference. Students can participate in as many Recognition Events as they want.

Recognition Events HOSA’s Recognition Events are designed to recognize members and chapters for outstanding work in HOSA and HOSA related projects. There are Recognition Events that HOSA offers, with recognition on both the state and national level.

The Recognition Events are:

• Health Care Issues Exam (no pre-judged components to be submitted)

• HOSA Service Project • Barbara James Service Award

• HOSA Happenings

Event guidelines and details for all Recognition Events are available on the state or national web sites on the Competitive Events page. Recognition will be given at the state level and the state determines national qualification.

Competitive Events

On-Line Testing—February 1-7th

NOTICE: All students competing in events that consist of a Written Test only OR a Round 1 Written Test must complete their test on-line during the testing window. All students in your chapter competing in the SAME event are required to test on the same day, preferably at the same time.

Advisors need to identify another adult to proctor the on-line tests and submit their name and email through the hosa.org website and email the completed Confidentiality Forms to office@wahosa.org by January 17th.

Tallo Uploads by February 7

th

The events listed below require submissions to be uploaded to Tallo by February 7th

. If listed below see event guidelines for the requirements.

Events with a Written Test ONLY to be

completed on-line February 1-7th

:

Events with a Round 1 Written Test

to qualify for Round 2 to be

completed on-line February 1-7th

:

Events that require

Tallo upload by February 7th:

• Knowledge Tests o Behavioral Health o Cultural Diversity & Health Disparity o Human Growth and Development o Medical Law and Ethics o Nutrition o Pathophysiology o Pharmacology o Transcultural Health Care

• Dental Terminology

• Foundations of Medical Terminology

• Health Career Exploration • Math for Health Careers

• Biomedical Debate

• Biomedical Laboratory Science

• CERT Skills • CPR/First Aid • Creative Problem Solving

• Dental Science • Dynamic Decisions

• EMT

• Forensic Science • Healthy Lifestyle • Home Health Aide

• HOSA Bowl • Life Threatening Situations

• Clinical Specialty • Community Awareness

• Health Career Display (no upload required for MS)

• Health Career Photography • Health Education (no upload required for MS)

• Healthy Lifestyle (no upload required for MS)

• HOSA Happenings • Interviewing Skills • Job Seeking Skills • Life Support Skills

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• Medical Math

• Medical Reading

• Medical Spelling

• Medical Terminology

• Healthcare Issues Exam

• Epidemiology (including case study)

• Medical Assisting

• Medical Spelling

• Nursing Assisting • Parliamentary Procedure

• Pharmacy Science

• Physical Therapy • Sports Medicine

• Veterinary Science

• Medical Innovation

• MRC Partnership

• Personal Care • Public Health (no upload required for MS)

• Public Service Announcement

• Researched Persuasive Writing and Speaking

• Speaking Skills

Competitive Event Finalists Process Certain competitive events consist of two rounds. Round One is an on-line, multiple-choice test of knowledge and understanding. Round Two is a performance/skill evaluation. The top scoring competitors from Round One proceed to Round Two. Competitors are encouraged to be prepared for both rounds, even though they may not participate in Round Two.

On-Line Test Proctor Information During the registration process, you will need to select a proctor who will administer the tests to your students. Proctors will receive confirmation emails by January 31, 2020. Proctor confirmation emails will provide login information to access all information needed to proctor tests. If proctors do not receive confirmation emails by this date, please request assistance at office@wahosa.org. A response will be provided within 24 hours of the request. Advisors and students including student officers are not allowed to be proctors. Nor should they have access to the proctor’s computer during testing or log in information (this would be grounds for chapter disqualification). On-line test proctor forms are due by January 17th.

OTHER EVENTS AND OPPORTUNITIES AT THE CONFERENCE Symposiums and Leadership Workshops Washington HOSA members are encouraged to attend symposiums and leadership workshops. Through these sessions, students will hear interesting speakers and engage in hands-on activities with professionals in the areas of leadership, college/career readiness, and health care!

Running for State Office During the State Leadership Conference, members will have the opportunity to run for an office on the 2020-2021 State Officer Team. All members that are dedicated to HOSA, have a passion for leadership, and enjoy working with others to improve the organization are encouraged to run for office. Being a State Officer for the Washington HOSA is an incredible honor. Each candidate must complete the 2020-2021 State Officer Candidate Application. The State Officer Candidate Applications are due by January 17, 2020. Only two applicants per chapter will be accepted.

Voting Delegates Each year student delegates elect the new team of state officers to serve the organization. When registering your chapter please register two (2) voting delegates. The voting delegates elect the new State Officers.

Courtesy Corps HOSA relies on our members to volunteer and help run a successful conference. The Courtesy Corps members assist with the competitive events, workshops, and other aspects of the conference. Please register at least two members of your chapter to be Courtesy Corps members.

Judging Opportunities The Washington HOSA competitive events program requires an extraordinary amount of time, effort, and volunteer spirit to be successful. If you know of individuals who would make excellent judges for our competitive events program, please direct them to Saraya Pierce at piercesaraya@newportgriz.com for more information.

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CONFERENCE PROCEDURES

Participant Forms The following forms must be completed as part of the State Leadership Conference registration process (form located at the end of this guide and at wahosa.org):

• Test Proctor Confidentiality and Advisor On-Line Testing Agreement Forms—Both forms to be completed by chapter advisors and proctors for each proctor registered to administer on-line tests.

• Medical Liability Release Forms—To be completed from every conference attendee and collected by the local advisor. The local advisor must keep these forms in their possession during the conference.

• Code of Conduct Form—To be completed from every student attendee and collected by the local advisor. The local advisor must keep these forms in their possession during the conference.

• Advisor Statement of Assurance Form—To be completed by each chapter’s advisor and submitted to Washington HOSA by the advisor on-site at registration.

The forms mentioned above are included at the end of this registration packet and at wahosa.org.

Conference Dress Code Washington HOSA follows National HOSA Dress Code. Refer to Appendix E on the national website at www.hosa.org. Appendix E can be found by selecting “Competitive Events” then “Appendices.”

Where to Submit Materials/Payments and/or Direct Questions Materials/Payments to Submit: Send To:

HOSA State and National Membership Dues Payment National HOSA 548 Silicon Drive, Suite 101 Southlake, TX 76092

SLC Conference Registration Invoice and Payment (received by March 1st)

ILC Conference Registration Invoice and Payment

Washington State HOSA PO Box 2733 Redmond, WA 98073

State Officer Candidate Application and Documents (by January 17th)

Upload to Tallo and email to Andy Goss, State Leadership Advisor agoss@wahosa.org

Recognition Event Materials (by February 7th) Upload to Tallo

Conference Hotel Reservation Form On-line Testing Proctor and Advisor Agreement Forms ILC Intent to Compete General Questions

office@wahosa.org

Event Judge Questions and Name Submission Email Saraya Pierce at piercesaraya@newportgriz.com

GENERAL REMINDERS As leaders and teachers of young professionals, it is important that we prepare our students for this upcoming event. The following information will help you to plan for the State Leadership Conference (SLC) and prepare your students with important information about the conference.

Code of Conduct/Curfew

Chapter advisors are responsible for the conduct of their chapter members. Unfortunately, simply checking to make sure your students are in their rooms at curfew does little to ensure they will stay there. Therefore, advisors should be visible in each hall for at least one hour past the published curfew. State conference curfew is 11:00 PM.

On-site Chaperoning Having your students check in with you at least three times per day is recommended. Let your students know of your whereabouts so they can easily do this. Have your students work together to remind each other of the times and locations for their events and activities. When you are busy assisting with an activity, make sure you let your students know where your assignment will be and have them write it down in their programs.

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Appreciation for SLC Staff, Judges and Volunteers Remind students to thank the event staff, judges, presenters, and volunteers. They appreciate knowing their hard work has benefited the students. If you plan to use parent chaperones, encourage your officers to plan a special way to thank them at the conference or upon returning home.

Publicity Your chapter and Washington HOSA, in general, welcome positive publicity. Use participation for the SLC to generate some positive publicity. It is always nice for the public to know you have participated before you have to earn dollars for the ILC.

Students with Disabilities Our office makes every attempt to accommodate students with disabilities at the conference. If you contact us prior to the conference, we can make the conference and competition as barrier free as possible. Please inform us about people with disabilities and any special accommodations that may be needed, such as wheelchair accessible sleeping rooms. Please inform Washington HOSA by February 1, 2020, of any special requirements that may be needed for competitions and sessions.

Event Managers All advisors will be required to sign up to assist in the management of a competitive event. The sign-up form will be out soon.

INTERNATIONAL LEADERSHIP CONFERENCE Students placing in the top five at State Leadership Conference need to fill out the ILC Intent to Compete Form and return it to office@wahosa.org by March 20, 2020.

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Test Proctor Confidentiality Agreement for Washington HOSA On-line Competitive Events Testing

As a designated on-line testing proctor I, ______________________________, understand/agree to the

following:

• Materials used for HOSA competitive events testing are confidential.

• To maintain the confidentiality of all testing materials and understand that the security of testing materials

is maintained by protecting all items from loss, unauthorized access, or reproduction.

• Maintaining test item security prohibits any test proctor from the following:

1. Unauthorized printing or photocopying any test items or materials, or

2. Accessing or removing test materials from the secure locations, or

3. Utilizing test items in any form, either from a copy of the test instrument or as a practice exercise to

expose candidates to the test items, or

4. Allowing students to access events at times other than their scheduled testing time, or

5. Allowing students to test in one event more than once, or

6. Allowing instructors and others to view test content.

7. Discussing test content and/or questions with others, i.e. participants, advisors, etc.

• I understand that access to testing will be given to and monitored by the proctor named below. Any

inconsistencies will be reported to the Washington State HOSA State Advisor for investigation. I further

understand that comprising test security in any way will result in the disqualification of all HOSA students

testing in this school.

Chapter/School Name: _________________________________________________________

Date(s) and Time(s) On-line Testing to Occur (Testing window February 1st

– February 7th

):

1st Date: ___________________ Start Time: _____________am/pm End Time: ____________am/pm

2nd Date: ___________________ Start Time: _____________am/pm End Time: ____________am/pm

3rd Date: ___________________ Start Time: _____________am/pm End Time: ____________am/pm

4th Date: ___________________ Start Time: _____________am/pm End Time: ____________am/pm

Testing Location (i.e. computer lab, library, classroom, etc.): _______________________________________

Proctor Information:

Full Name: _________________________________________________

Position w/School District: __________________________________________________________________

Phone Number: (________) ________ - ______________

Email: _______________________________________________________

Signature: _____________________________________________ Date: __________________

1. Determine dates for your students to test. On-line testing window: February 1st

– February 7th

2. Register proctors through the local advisor portal at hosa.org.

3. Scan & email Test Proctor Confidentiality Agreement and Advisor On-Line Testing Agreement forms (both

forms to be completed for each proctor utilized for testing) to office@wahosa.org by January 17, 2020.

4. An email granting access to the online testing materials to the proctor will be sent at least 1 day before on-

line testing is to occur.

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Advisor On-Line Testing Agreement

for Washington HOSA On-line Competitive Events Testing (Source: Arizona State HOSA)

As chapter advisor/instructor I, _____________________________________, understand that materials used

for HOSA competitive events testing are confidential and that the security of testing materials is maintained by

protecting all items from loss, unauthorized access, or reproduction.

In order to maintain the integrity for testing and competitive process, I further understand that

Advisors/Instructors are not allowed to access or view tests at any time and that instructors/advisors are not

allowed to question proctors or students about test content.

Maintaining test item security prohibits any test proctor from:

• Unauthorized printing or photocopying any test items or materials, or

• Accessing or removing test materials from the secure locations, or

• Utilizing test items in any form, either from a copy of the test instrument or as a practice exercise to expose candidates to the test items, or

• Allowing students to access events at times other than their scheduled testing time, or

• Allowing students to test in one event more than once, or

• Allowing instructors and others to view test content

• Discussing test content and/or questions with others, i.e. participants, advisors, etc.

I understand that the 2020 WA HOSA on-line testing window dates are February 1-7, 2020.

I understand access to testing will be monitored by (assigned

proctor’s full name) and inconsistencies will be reported to the Washington HOSA State Advisor for

investigation.

I further understand that compromising test security in any way will result in the disqualification of all HOSA

students testing at this school.

Chapter/School Name: Chapter Number: _______________

Advisor/Instructor Name: _____________________________________________

Advisor/Instructor Signature: ________________________________________ Date: ________________

Complete, scan and email Advisor On-Line Testing

Agreements and Test Proctor Confidentiality Agreements

to office@wahosa.org by January 17, 2020.

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Student Delegate Medical Liability Release Form

Due to legal restrictions, it is necessary that all student delegates complete this form to be eligible to attend WA HOSA Leadership Conferences. Local Advisors should collect completed forms from each student delegate and submit them to WA HOSA personnel at conference registration. Advisors are responsible for having copies of all forms with them during the conference.

PLEASE PRINT ALL INFORMATION IN PEN

Student Delegate Name ______________________________________________

Parent/Guardian Name ______________________________________________

Home Address ______________________________________________________________________________

Home Phone (________)_________________________ Cell Phone (________)________________________

Alternate/Emergency Contact Name _________________________________________________

Home Phone (________)_________________________ Cell Phone (________)________________________

Local Advisor Name _________________________________________________

School/Chapter Name ___________________________________________________________________

Delegate is covered by group or medical insurance? _____No _____Yes (If “Yes”, provide the following)

Insured’s Name ________________________________ Insurance Company ______________________________

Group # ___________________________ Policy #___________________________________

Physician Name _________________________________________ Phone (________)_____________________

Physician’s Address __________________________________________________________________________

Please describe any medical condition(s) which may recur or be a factor in medical treatment.

a. Allergies: _________________________________ e. Physical Handicap: _______________________________

b. Convulsions: ______________________________ f. Medicine Reactions: _______________________________

c. Blackouts: ________________________________ g. Disease of any kind: _______________________________

d. Heart/lung issues: __________________________ h. Other: __________________________________________

If currently taking medication(s), please list below.

Medication(s) _________________________________________________________________________________

Parent/Guardian (or Student Delegate if at least 18 years of age), please check one of the following:

� I give permission for immediate medical treatment as recommended by an attending physician and/or other qualified healthcare provider. Notify me and/or any persons listed above as soon as possible.

� I do not give permission for medical treatment until I have been contacted.

LIABILITY RELEASE

I certify that the information provided is accurate and complete to the best of my knowledge. I understand that each individual is responsible for his/her own insurance coverage during this trip. I hereby release the National HOSA Board of Directors, the National Staff, State and Local HOSA Associations, and any designated individual in charge of the HOSA group or specific activity from any legal or financial responsibility with respect to my personal or my student/child’s participation in or contact with any known element associated with an activity including competitive events.

Parent/Guardian’s Signature _______________________________________________ Date __________________ (Applicable if student delegate is under the age of 18)

Student Delegate’s Signature ______________________________________________ Date __________________

Local Advisor’s Signature ________________________________________________ Date __________________

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Student Delegate Code of Conduct

A good reputation enables members to take pride in their organization. HOSA members have an excellent reputation. Your conduct at any HOSA function should make a positive contribution to the reputation that has been established.

1. Your behavior at all times should be such that it reflects credit to you, your school/college, your state and HOSA.

2. Student conduct is the responsibility of the local chapter advisor. Students shall keep their advisors informed of their activities and whereabouts at all times. (WA HOSA conference name badges shall be worn at all times during the conference)

3. You are expected to attend all scheduled conference activities and appropriate competitive events. Please be prompt and show respect to those in the audience and on stage.

4. Members are to report any accidents, injuries or illnesses to their local or state advisor immediately.

5. Members are expected to observe the designated curfew. “Curfew” means that each person must be in own room by the designated hour.

6. If a student is responsible for stealing or vandalism, the student and his/her parents/guardians will be expected to pay any and all damages.

7. Members/participants attending the WA HOSA State Leadership Conference may not purchase, consume or be under the influence of alcohol or drugs at any time. Violators will be subject to stringent disciplinary action.

8. Substance abuse (i.e. drugs, alcohol, smoking/vaping, etc.) is not permitted.

9. Students who disregard the rules will be subject to disciplinary action and will be sent home at their own expense. Parents/Guardians will be notified.

10. Any long distance phone calls, charges to the hotel room, etc. will be the responsibility of the individual student and/or parents/guardians.

11. Members are to abide by the WA HOSA attire policy at all sessions and workshops.

In signing below, I indicate having read the Code of Conduct and agree to abide by these rules.

_________________________________________________________ Printed Name of Student Delegate

_________________________________________________________ ____________________ Student Delegate Signature Date

_________________________________________________________ Printed Parent/Guardian Name

_________________________________________________________ ____________________ Parent/Guardian Signature (if student delegate is under the age of 18) Date

_________ Parent/Guardian or Student Delegate (if 18+ years of age) Initials

Initialing signifies permission for WA HOSA to make photographs, videotapes, broadcasts, and/or sound recordings, separately or in combination, of student delegates available for reproduction for educational and promotional purposes by International HOSA or WA HOSA.

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Advisor/Chaperone/Guest Medical Liability Release Form

Due to legal restrictions, it is necessary that all WA HOSA advisors and guests/chaperones complete this form to be eligible to attend the WA HOSA State Leadership Conference. This form should be collected by Local Advisors and submitted to WA HOSA personnel at the conference registration table. Advisors are responsible for having copies of all forms with them during the conference.

PLEASE PRINT ALL INFORMATION IN PEN

Advisor/Chaperone/Guest Name ______________________________________________________________

Home Address __________________________________________________________________________________

Home Phone (_______) __________-____________ Cell Phone (_______) __________-____________

Email ______________________________________________________________

School/Chapter Name ___________________________________________________________________________

Emergency Contact ________________________________________ Relationship ________________________

Home Phone (_______) __________-____________ Cell Phone (_______) __________-____________

Physician Name __________________________________________ Phone (_______) __________-____________

Advisor/Guest is covered by group or medical insurance? ______ Yes ______ No

If yes, complete the following information:

Name of Insured _________________________________________________

Insurance Company ____________________________________________________________________

Group # _______________________________ Policy # _______________________________________________

Please describe any medical condition(s) which may recur or be a factor in medical treatment.

a. Allergies _______________________________ e. Physical Handicap ________________________________

b. Convulsions ____________________________ f. Medicine Reactions _______________________________

c. Blackouts ______________________________ g. Heart/lung issues _________________________________

d. Other ______________________________________________________________________________________

If currently taking medication(s), please provide the following information.

Name of Medication(s)/Dosage _________________________________________________________________

_____________________________________________________________________________________________

Prescribing Physician’s Phone Number (_______) __________-____________

In the event of a medical emergency (check one of the following):

� I give my permission for immediate medical treatment as recommended by an attending physician and/or other qualified healthcare provider. Notify any persons listed above as soon as possible.

� I do not give permission for immediate medical treatment. Notify any persons listed above as soon as possible.

LIABILITY RELEASE—I certify that the information above is accurate and complete to the best of my knowledge. I understand that each individual is responsible for his/her own insurance coverage during this trip. I hereby release the WA HOSA Board of Directors, State and Local HOSA Associations, and any designated individual in charge of the HOSA group or specific activity from any legal or financial responsibility with respect to my personal participation in or contact with any known element associated with an activity including competitive events.

Advisor/Chaperone/Guest Signature _________________________________________ Date _______________

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Washington HOSA Statement of Assurance Washington HOSA State Leadership Conference March 5-7, 2020

As the advisor responsible for the students attending this event, I confirm that:

• I have reviewed the Medical Release Form and the Code of Conduct with my students. I will have a

completed copy of the Code of Conduct for each student attending in my possession for the duration of

the above event, including travel to and from this event.

• I understand that Washington HOSA will not collect the individual Code of Conduct forms for this event

and that they are to be kept in my possession.

• I understand that students attending the above event will have the opportunity to participate in activities

outside of the conference facility, thus requiring walking or further public transportation. I have

discussed this with the students and their parents/guardians and have also informed them of proper

etiquette and safety precautions while traveling in/around metropolitan areas.

• I understand that I am expected by Washington HOSA to remain on-site with my students.

• I understand that proper completion of the Medical Release and Code of Conduct forms provides the best

protection for my students’ needs and my liability during a Washington HOSA event.

• I have checked with my administrator and have secured authorization for my chapter to travel to this

event and have reviewed all school/district policies regarding supervision of students on trips and will

abide by them.

• The responsibility for the safety of the delegates from this chapter rests with people signing this

Statement of Assurance.

• I will participate in all general sessions during the conference and fulfill my assigned responsibilities

during the conference.

• I will patrol the halls (even during the day, if necessary), stay up until students and/or halls are quiet,

enforce the conference Code of Conduct and Dress Code, and regularly check-in with my students.

• I will ensure that myself and chaperones assisting me will:

o Be 21 or older

o Follow the conference Code of Conduct and Dress Code

o Act responsibly and interact appropriately with students

I have read the above and hereby offer assurance that I understand and agree to comply with the policies stated

on the Medical Release and Code of Conduct forms as indicated by my signature appearing below.

Printed Name:

Advisor Signature:

School/Chapter Name:

Date:

Advisors attending Washington HOSA events must review and sign this statement of

assurance. This form will be collected at the SLC registration desk.