2016 nfhs national student leadership summit -...

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National Federation of State High School Associations

2016 NFHS NationalStudent Leadership

Summit

Student/AdultAmbassador Application

July 17 – 20, 2016

at the Indianapolis HyattRegencyIndianapolis, Indiana

Take Part. Get Set For Life.™

TOMORROW’S LEADERS – HIGHSCHOOL ACTIVITYPARTICIPANTS

Incredible attention is being paid tohigh school athletics and activitiestoday; high school activity participantsare looked upon as leaders because oftheir position on the team or club. Theirimpact on the climate and culture oftheir schools and other students isenormous. In fact, studies show thatmore than one-half of high school stu-dents participate in some sort of schoolactivity or athletic program. Theirinvolvement in the success of a highschool is paramount and critical. TheNational Federation of State HighSchool Associations (NFHS), whichserves more than 11 million studentsnationwide each year, wants to be theleader in training talented, committedyoung people to become better citizensand who will be positive, contributing adults. We arepleased to announce that the NFHS ishosting the National StudentLeadership Summit, with the theme“Take Part. Get Set For Life.”

The NFHS is excited about its neweststudent leadership initiative – theNational Student Leadership Summit(NSLS). The NSLS will focus on relevantand contemporary issues affectingtoday’s students in education-basedathletics and performing arts. Studentswill sharpen their leadership skills andwill realize the privilege and power oftheir influence in their school, commu-nity and state.

By utilizing a “train the trainer” con-cept, each student ambassador willlearn how to develop and maintainhealthy relationships with teammates,

coaches/adult leaders and officials. Theywill learn conflict-resolution techniquesand understand how to be better com-municators with their peers and adults.They also will learn the value of per-spective and inclusion. Experts will dis-cuss these issues in a lecture/interactiveformat in small group breakout classes.

Although the student (or state associa-tion) is responsible for transportation toand from the summit, the NFHS coversall other expenses: hotel room, materi-als, meals and local ground transporta-tion. Adult ambassadors must providefor their own transportation and hotelroom although summit materials, mealsand local ground transportation will beprovided by the NFHS.

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Take Part.Get Set For Life.™

ABOUT THE NFHS. . .

The NFHS stands for the National Federationof State High School Associations. It writesplaying rules for 17 high school sports, andcoordinates the national high school debatetopic. Since 1920, the NFHS has led thedevelopment of education-based inter-scholastic sports and activities that help stu-dents succeed in their lives. We set directionsfor the future by building awareness andsupport, improving the participation experi-ence, establishing consistent standards andrules for competition, and helping those whooversee high school sports and activities.Through the work of its member state highschool associations, the NFHS is responsiblefor more than 11 million students participat-ing in sports, spirit programs and performingarts. The young people who are selected area privileged group of individuals, becausethey represent their schools, states andthemselves in Indianapolis in July 2016.

Q: WHO ARE PERFORMING ARTISTS?Those talented individuals involved in speech,debate, music, theatre and band. There areapproximately four million students who arepart of their school’s performing arts pro-grams and more than 7.5 million who areinvolved in athletics.

Q: WHY IS THE NFHS HOSTING THE NSLS?

This is the only national student leadershipsummit for athletes and performing arts par-ticipants. The NFHS feels these individualshave inherent leadership abilities and are the leaders of the future. The NFHS plans todirect these high school students on how todevelop their leadership abilities and interactwith their peers from around the UnitedStates and other countries.

Q: WHAT IS THE CONFERENCEATMOSPHERE AND ATTIRE?

This is a relaxed atmosphere to encouragelearning and facilitate interaction. The mid-80 degree weather dictates casual clothes-jeans, shorts, skirts, sneakers, t-shirts wouldbe appropriate for the majority of the confer-ence functions. There is one occasion thatyour attire needs to be aligned with theevent. The event is a celebration dance onTuesday evening before you depart forhome. This is not a black-tie affair, but werecommend you wear casual clothes that youcan dance in. As part of your registration, wewill provide you with two t-shirts (one con-ference and one travel shirt for your tripback home on Wednesday).

Q: GREAT, I WANT TO GO! WHAT DO I HAVE TO DO?

Ask your school principal to contact yourlocal state athletic/activity association formore information or check out the NFHSwebsite, www.nfhs.org.

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INDIANAPOLIS The 12th largest city in the nation and thecapital of Indiana, the Circle City is the center of America’s heartland. More than 65percent of the U.S. population lives within a700-mile radius of Indianapolis. More inter-states converge in Indianapolis than in anyother city in the United States, which makesit one of America’s most accessible cities.

The Arts play an important part in the livesof the people of Central Indiana and enrichthe culture of the community. Indianapolissupports more than 200 arts organizations,including a world-class symphony, theater,opera, ballet, museums and art galleries.

Indianapolis offers a wide range of restau-rants catering to tastes from traditionalIndiana fare to gourmet vegetarian or inter-national dishes. Nightlife offers somethingfor everyone, including comedy clubs, danc-ing and dinner theaters.

Indianapolis certainly deserves its unofficialdesignation as “Amateur Sports Capital ofthe World.” The city has state-of-the-artfacilities for numerous sports, including ven-ues that have hosted world-class competi-tions. Indianapolis offers something for alltypes of sports fans: the annual N.H.R.A.Nationals, Indianapolis 500 Mile Race,Brickyard 400, the NFL Indianapolis Colts, theNBA Indiana Pacers, the WNBA IndianaFever, the Indianapolis Indians baseball teamand the Indianapolis Fuel hockey team. Thecity is also known for its support of highschool sports and activities.

The downtown White River State Parkincludes the 78-acre Indianapolis Zoo featur-ing over 2,500 exotic and domestic animalsexhibited in “cageless” simulated naturalhabitats of the world’s waters, deserts, plainsand forests. The Zoo includes Indiana’slargest aquarium and the nation’s only totallyenclosed environmentally controlled whaleand dolphin performance center. The WhiteRiver Botanical Gardens are adjacent to thezoo located across the White River from theNFHS office.

The Hyatt Regency Indianapolis is a jewel inthe downtown lodging crown. It is near theLucas Oil Stadium (home of the NFL Colts)and Indiana Convention Center and blocksfrom Bankers Life Fieldhouse, home of theNBA Pacers and WNBA Fever. The HyattRegency Indianapolis is steps away fromdowntown Indianapolis restaurants and the-atres. The hotel is next to Circle Center Mall,which includes a variety of specialty stores.

Horse-drawn carriage tours of the sights inthe downtown area are available days andevenings.

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2016 NFHS National Student Leadership Summit

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ADULTAMBASSADORAPPLICATION

(Please Print)

1 Male 1 Female

First and Last Name ______________________________________________________________

Home Address __________________________________________________________________

City _____________________ State ____________________ Zip ________

Home Telephone Number __________________ Cell Phone Number ___________________

Email Address ___________________________________________________________________

T-shirt Size (based on men’s sizing) _________________________________________________

School/Association Name _________________________________________________________

School/Association Twitter Handle __________________________________________________

School/Association Address _______________________________________________________

City _____________________ State ____________________ Zip ________

School/Association Telephone Number ______________________________________________

Principal's/Executive Director’s Name ________________________________________________

Principal's/Executive Director's Email Address ________________________________________

Describe the activities you supervise, coach or advise.

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In 200 words or less, please answer the question on the next page.

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ADULTAMBASSADORAPPLICATIONSECOND PAGE

In 200 words or less, please answer the following question:

Why is learning to be a better leader important to you?

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If I am selected as one of my state’s delegates, I agree to attend the NFHS National StudentLeadership Summit, July 18-20, 2016, in Indianapolis, Indiana.

Signature _________________________________ Date ________________

Return no later than May 1, 2016, toyour local state association office.

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STUDENTAMBASSADORAPPLICATION

(Please Print)

1 Male 1 Female

Student’s First and Last Name _____________________________________________________

Student’s Home Address __________________________________________________________

City _____________________ State ____________________ Zip ________

Home Telephone Number _________________ Student Cell Phone Number _____________

Email Address ___________________________________________________________________

Parent or Guardian Name _________________________________________________________

Address ________________________________________________________________________(If different from student)

T-shirt Size (based on men’s sizing) _________________________________________________

School Name ___________________________________________________________________

School/Association Twitter Handle __________________________________________________

School Address __________________________________________________________________

City _____________________ State ____________________ Zip ________

School Telephone Number ________________________________________________________

Principal's Name _________________________________________________________________

Principal's Email Address __________________________________________________________

Current Grade in School __________________________________________________________

List all school and community activities you are involved in with an emphasis on leadershiproles.____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

In 200 words or less, please answer the question on the next page.


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STUDENTAMBASSADORAPPLICATIONSECOND PAGE

In 200 words or less, please answer the following question:

a. Why is learning to be a better leader important to you?

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b. How will you apply the skills and techniques learned to your team or group?

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If I am selected as one of my state’s delegates, I agree to attend the 2016 NFHS NationalStudent Leadership Summit, July 18-20, 2016, in Indianapolis, Indiana.

Student Signature ________________________________________ Date ________________

Parent/Guardian Signature _________________________________ Date ________________

To be submitted with the Student Health History/Consent for Treatment Form, the Code of Conduct, the Liability and Release Waiver.


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STUDENT HEALTHHISTORY/CONSENTFOR TREATMENT

(Please Print)

Student’s First and Last Name _____________________________________________________

Student’s Home Address __________________________________________________________

City _____________________ State ____________________ Zip ________

Home Phone Number ____________ 1 Male 1 Female Date of Birth _________ Age_____

Parent or Guardian Name _________________________________________________________

Mother Phone Numbers – Home ______________ Work _____________ Cell _____________

Father Phone Numbers – Home ______________ Work _____________ Cell ______________

Emergency Phone Number (Other than parent/guardian) Name _________________________

Relation to Student ______________________________________________________________

Family Physician _____________________________ Physician Phone Number _____________

Insurance Company ______________________ Group Plan Number _____________________

Policy Number ______________________ Insurance Benefit Code _______________________

Does the student have any special physical needs? Yes No

If yes, please explain _____________________________________________________________

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Does the student have any special dietary needs? Yes No

If yes, please explain _____________________________________________________________

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Is student allergic to any drugs? (e.g. penicillin, insulin) ________________________________

Is student allergic to bee stings? ________Can student take antihistamines? ______________

Is student currently under any medical treatment? (please explain) ______________________

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Medication student is currently taking (includes antihistamines, anti-convulsives, tranquilizers,

insulin, etc.) ____________________________________________________________________

Any special health problems? (Past and Present) ______________________________________

List operations within the past year _________________________________________________

Emotional problems (e.g. hyperventilation, hysteria, depression, etc.)

_______________________________________________________________________________

(This document will be retained in confidence by the Leadership Conference Medical Director)

To be submitted with the Student Ambassador Application (2 pages), the Code ofConduct, the Liability and Release Waiver.

"I hereby give permission for the above named student to be treated by a physician orlicensed nurse at a hospital or on the scene in the event of a medical or surgical emergency."

Parent/Guardian Signature _________________________________ Date ________________

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RELEASE AND WAIVER OF LIABILITYAND INDEMNITYAGREEMENT (the "Agreement") FOR THE NFHS NationalStudent Leadership Summit, July 18-20,2016(The "Event")

In consideration for being permitted to observe, work for, or for any purpose participate inany way in the Event, EACH OF THE UNDERSIGNED, for him or herself, his personal represen-tatives, heirs, next of kin, acknowledges, agrees, and represents that he has, or will immedi-ately upon entering the Event:

1. RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE: The National Federation ofState High School Associations (NFHS), any and all sponsors of the Event, their sub-sidiaries, parents, affiliates, officers, directors, agents and representatives, the Event pro-moters, participants, venue operators and owners, city officials, competitors, technicians,any persons in any restricted area, lessees of premises used to conduct the Event and eachof them, all for the purpose herein referred to as "releasees", from all liability to the undersigned, his personal representatives, assigns, heirs, and next of kin forany and all loss or damage, and any claim or demands therefore on account of injury tothe persons or property resulting in death of the undersigned, whether caused by thenegligence of the releasees or otherwise while the undersigned is in or upon any restrict-ed areas, and/or, competing, officiating in, observing, working for, or for any purposeparticipating in the Event.

2. AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releasees and each of themfrom any loss, liability, damage, or cost they may incur due to the presence of the under-signed in or upon the restricted areas or in any way competing, officiating, observing, orworking for, or for a any purpose participating in the Event and whether caused by thenegligence of the releasees or otherwise.

3. ASSUME FULL RESPONSIBILITY FOR ANY RISK OF BODILY INJURY, DEATH OR PROPERTYDAMAGE due to the negligence of releasees or otherwise while in or upon restrictedareas and/or while participating, observing, working for, or for any purpose participatingin the Event. EACH OF THE UNDERSIGNED EXPRESSLY ACKNOWLEDGES AND AGREESTHAT THE ACTIVITIES OF THE Event are dangerous and involve the risk of serious injuryand/or property damage. EACH OF THE UNDERSIGNED further expressly agrees that theforegoing release, waiver, and indemnity agreement portion thereof is intended to be asbroad and inclusive as is permitted and that if any portion thereof is held invalid, it isagreed that the balance shall, notwithstanding, continue in full legal force and effect.

4. THE UNDERSIGNED hereby grants permission to the NFHS full permission now and forever, with no obligation to compensate me further, to use photographs, videotapes,motion pictures, recordings, or other record of my participation for advertising and promotional materials and for any other purpose the NFHS, in its sole discretion deemsnecessary. This includes the posting of such photographs, recordings, or other media rep-resentation of myself, on any website, or licensing others to do so in their promotionalmaterials or websites.

NOTICE: BY SIGNING THIS RELEASE AND WAIVER OF LIABILITY AND INDEMNITYAGREEMENT, RELEASEOR IS AGREEING TO HAVE ANY CLAIM DECIDED BY NEUTRALARBITRATION AND IS GIVING UP THE RIGHT TO A JURY OR COURT TRIAL. THE UNDER-SIGNED HAS READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY ANDINDEMNITY AGREEMENT, and further agrees that no oral representation, statements orinducements apart from the foregoing written agreement have been made.

Print Student Name _____________________________________ Date ________________

Student Signature _______________________________________ Date _______________

Legal Parent/Guardian Signature __________________________________ Date ___________(If you are under 18)

To be submitted with the Student Ambassador Application (2 pages), the Code ofConduct, and the Student Health History/Consent for Treatment Form.


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CODE OF CONDUCT Student Name _______________________________ School ___________________________

I, the undersigned student leader, do hereby agree: 1. To abide by all the rules and regulations set forth by the National Federation of State

High School Associations, the Adult Ambassadors, and all adult supervisors. 2. To waive and release any and all rights and claims for any damages I may have against

the National Federation, the state association, and any other employee of the NFHS, forany injuries arising from my participation in this activity.

3. To accept responsibility for my behavior so that it does not reflect discredit on myschool, my state association, or myself.

4. To use no tobacco, alcohol or illegal drugs at the Summit. 5. To treat all student and adult ambassadors, college and adult staff, NFHS staff, speak-

ers, and hotel staff with respect and dignity.

I understand that if I break any of the rules of the Summit that I will be sent home immedi-ately at my own expense, after the NFHS has made arrangements with my parent/legalguardian.

Signature ________________________________________________ Date ________________

Print Name _____________________________________________________________________

I, the parent/guardian of the above signed student, understand the obligations accepted bymy son/daughter as outlined above and give my consent for his/her participation in the 2016NFHS National Student Leadership Summit. I do further release the National Federation ofState High School Associations and my State Association, sponsors of this summit, and anyother employee of said organizations from any claim for damages incurred by the said stu-dent that might be a direct or indirect outgrowth of his/her participation in this conference.

Signature ________________________________________________ Date ________________

Address ________________________________________________________________________

Telephone Number ______________________________________________________________

To be submitted with the Student Ambassador Application (2 pages), the StudentHealth History/Consent for Treatment Form, and the Liability and Release Waiver.


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TENTATIVEDELEGATE SCHEDULE

July 17-20, 2016Indianapolis, Indiana

Sunday, July 17, 2016

1:00 p.m. – 5:00 p.m. EarlyRegistration (Student and AdultAmbassador rooms only)3rd Floor, Hyatt Regency in hallway

Monday, July 18, 2016

1:00 p.m. – 5:00 p.m. Registrationand Room assignment (Student andAdult Ambassadors)(Food and refreshments will be pro-vided.)5:00 p.m. – 5:15 p.m. OpeningCeremony, Summit Objectives,Expectations and Directions5:15 p.m. – 6:00 p.m. OpeningGeneral Session Speaker6:05 p.m. – 7:05 p.m. Dinner7:15 p.m. – 8:30 p.m. StudentAmbassador Session 17:15 p.m. – 8:30 p.m. AdultAmbassador Session 1 (Summit Q &A, Objectives and Expectations)8:35 p.m. – 9:05 p.m. StateMeeting #1(Leadership Lounge is open until11:30pm)

Tuesday, July 19, 2016

7:00 a.m. – 8:00 a.m. Breakfast8:15 a.m. – 9:30 a.m. StudentAmbassador Session 28:15 a.m. – 9:30 a.m. AdultAmbassador Session 2 [Select abreak-out session to observe]9:40 a.m. – 10:55 a.m.Student Ambassador Session 3

9:40 a.m. – 10:55 a.m. AdultAmbassador Session 3 [Select abreak-out session to observe]11:05 a.m. – 12:20 p. m.Student Ambassador Session 4 11:05 a.m. – 12:20 p. m. AdultAmbassador Session 4 (Recap andSpecial Guest Speaker)12:30 p.m. – 1:30 p.m.Lunch & Announcements1:40 p.m. – 2:10 p.m. StateMeeting #22:35 p.m. – 2:55 p.m. Load buses2:55 p.m. – 3:30 p.m. Travel forSpecial Olympics Unified SportsExperience for Athletic ActivityEngagement w/ Indiana SpecialOlympians5:00 p.m. – 6:15 p.m. Pizza Dinnerat location6:15 p.m. – 6:30 p.m. Load Buses6:30 p.m. – 7:00 p.m. Return toHotel, free time to prepare fordance8:15 p.m. – 11:30 p.m.Dance (Food, refreshments and sun-dae bar)(Leadership Lounge is open until12:30 a.m.)

Wednesday, July 20, 2016

6:30 a.m. – 8:00 a.m. Breakfast8:10 a.m. – 9:00 a.m.StateMeeting #39:15 a.m. – 9:45 a.m. ClosingGeneral Session (Leadership Loungeopen 6:30 a.m. – 12:00 p.m.)

NOTES

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PO Box 690 | Indianapolis, IN 46206Phone: 317-972-6900 | Fax: 317.822.5700

www.nfhs.org

National Federation of StateHigh School Associations

PHOTOGRAPHS FROM PREVIOUS NFHS NATIONAL STUDENT LEADERSHIP EVENTS

2016 nfhs national student leadership summit -...

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