Arizona Association FFA

Medical Consent, Conduct Agreement and Photo/Video Release

Please check the activities that may apply:

ActivityDateLocation

2017 May COLT / May 5-6, 2017 / ASU Poly/Four Points Sheraton 6850 E Williams Field Rd
2017 State Leadership Conf. / June 1-3, 2017 / Radisson Hotel Tucson Airport and the UofA
2017 State FFA Camp / June 12-16, 2017 / Camp Shadow Pines, Heber, Arizona
2017 August COLT / August 25-26, 2017 / ASU Poly/Four Points Sheraton 6850 E Williams Field Rd
2017 Greenhand Conference / Sept. 11- Oct. 2 / 6, 1-day conferences at Safford, Chandler, Tucson, , Millennium, AWC (Yuma), Flagstaff, respectively
2017 360o Conference / Sept. 11- Oct-2 / 6, 1-day conferences at Safford, Chandler, Tucson, , Millennium, AWC (Yuma), Flagstaff, respectively
2017 Greenhand and 360 Conferences / October 2nd / Winslow
2017 National Convention / October 25-28, 2017 / Louisville, Kentucky
2017 Midwinter Conference / December8, 2017 / ASU Polytechnic, Mesa
2018Gila Southern CDE Day / February 14, 2017 / Safford High School
2018 Spring Conference / March 2, 2017 / U of A, Tucson
2018Yuma CDE Day / April 27, 2017 / Arizona Western College, Yuma
2018 May COLT / May 4-5, 2017 / ASU Poly/Four Points Sheraton 6850 E Williams Field Rd
2018 State Leadership Conf. / June 7-9, 2017 / Doubletree Hotel and the UofA
2018 State FFA Camp / TBD / TBD

Students who do not have this completed form on file with their school and Arizona FFA by the indicated deadline date, will be ineligible to participate and/or may not be admitted to the indicated event.

TRAVEL CONSENT

I hereby give my son / daughter, , a member of the ___Winslow______FFA Chapter, permission to participate in the activities identified and approve the transportation arrangements made by the local chapter for the location(s) and date(s) listed above.

MEDICAL CONSENT

I, ,

(Parent or guardian’s name)(Relationship to member)

of , , of ______

(Name of member)(Age)(Complete home address, including zip code) )

hereby authorize in advance any necessary medical treatment required while he/she is absent from home for activities as listed above.Please attach a statement indicating any pertinent medical information, allergies, etc.

(Name of family doctor)(Phone Number)

Medical Insurance Carrier Policy Number

Signature of Parent or Guardian Date

Contact phone number(s) for parent:

Signature of Witness Date

PHOTO/VIDEO RELEASE

I hereby grant permission for the use of any photos/video footage which may used on the internet, in videos or in other publications produced by Arizona FFA and other organizations deemed appropriate, including but not limited to Arizona Department of Education, Career and Technical Education, Association of Career and Technical Education, Association of Career and Technical Education Arizona, Arizona Technology and Industrial Education Association.

CONDUCT AGREEMENT

I commit to follow the guidelines for student code of conduct as outlined by the Arizona Association FFA. These guidelines are found in the Policies and Procedures document which can be found online at azffa.org (click on “Downloads”, open folder entitled “Constitution-Bylaws and Policies-Procedures (Public)”). I will exhibit excellent behavior that will enable me to receive benefits from each event in which I have chosen to participate. Failure to abide by these guidelines and any verbal guidelines given to me at the Arizona FFA event may result in my expulsion from the event, the FFA organization and/or further consequences at my home school.

Student Signature:______Date:______

Parent/Guardian Signature: ______Date: ______

Advisor Signature: ______Date:______