NEVADA CTSO LEADERSHIP RALLIES 2017 REGISTRATION FORM – FORM 1 Complete the following information to register your chapter for the 2017 CTSO Leadership Rally. Please type all information so that it can be read correctly. Upload the completed form no later than 4:00 PM CST on Friday, November 17, online via your association website.
Payment must be mailed directly to CTSO Events, P. O. Box 912, Jacksonville, OR 97530 with a copy of Form 1 to arrive no later than Thursday, November 30. Late fees will be assessed on all registrations submitted after November 17 or if payment is received after November 30.
School: Organization (Mark your CTSO) Advisor Name: DECA Daytime Phone: FBLA HOSA Email: FCCLA
Which LEADERSHIP RALLY will you attend? (Mark one) Elko (12/4—FBLA/FCCLA only)
Reno (12/5)
Las Vegas (12/6)
# Students Attending Rally x $60 =
# Adults Attending Rally x $60 =
Late Fees ($10/person after 11/17) x $10 =
TOTAL DUE: $
1. Upload this Form, along with Forms 2, 3 and 4 (if applicable), by November 17 online via the link on your CTSO Website. 2. Make Check payable to CTSO Events and send, with a copy of this form, to be received by November 30 to: CTSO Events P. O. Box 912 Jacksonville, OR 97530
Upload this completed form by November 17 to the link on your association website. NEVADA CTSO LEADERSHIP RALLIES 2017 REGISTRATION FORM – FORM 2
School: Advisor Name:
Organization City (Mark your CTSO) (Mark your Leadership Rally) DECA Elko (FBLA/FCCLA only) FBLA Reno (All Associations) HOSA Las Vegas (All Associations) FCCLA
Name Status Dietary Needs Vegetarian, Lactose List as it should appear on their name badge Advisor/Chaperone/Student or Gluten Free
Use a second sheet if needed. Please number pages.
Upload this completed form by November 17 to the link on your association website. NEVADA CTSO LEADERSHIP RALLIES 2017 STATEMENT OF ASSURANCE - FORM 3
Advisors attending the Leadership Rally events must review, sign, and return this statement of assurance along with their registration materials for each DECA/FBLA/FCCLA/HOSA conference/event.
Nevada Leadership Rally 2017
As the advisor responsible for the students attending this event, I confirm that: I have reviewed the Permission/Medical Release Form with my students, and I will have a completed copy of the Permission/Medical Release Form for each student attending in my possession for the duration of the above event, including travel to and from this event.
I understand that Nevada DECA/FBLA/FCCLA/HOSA will not collect the individual student forms for this event and that they are to be kept in my possession.
I understand that students attending the above event may 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 proper completion of the permission/medical release form provides the best protection for my students’ needs and my liability during a Nevada DECA/FBLA/FCCLA/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.
Nevada DECA/FBLA/FCCLA/HOSA requires a chaperone to student ratio of 1:15 at the CTSO Leadership Rallies.
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 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 Permission Forms as indicated by my signature appearing below. (Typing/writing your name in the box below serves as your signature and confirmation of understanding): Advisor Signature: Chapter Name: Date:
Upload this completed form by November 17 to the link on your association website. NEVADA CTSO LEADERSHIP RALLIES 2017 SERVICE FOR STUDENTS WITH SPECIAL NEEDS - FORM 4
If you have a student who has special learning or other special needs, please indicate those needs here. Please fill in the information as completely as possible to help us provide a positive learning experience for all our conference participants.
______Name of Student Chapter
Event Name:
Are there any specific conditions that we need to be made aware of?
Service or Accommodation Requested:
Upload this completed form by November 17 to the link on your association website.