Statement of Assurance

2008-09 School Year
This form is only completed once per school year and verifies
that each attending student has completed the 2008-09 Medical & Liability Release Form.

Advisors: Keep your students Medical and Liability Release form on-hand at each conference.
Do NOT send copies to the SkillsUSA office.

Student & Advisor
Medical and Liability
Release Form

Every student and advisor must complete this form once per year. Advisors keep these forms on-hand for each conference.
2008-09 Medical & Liability Release Form (Word, PDF).

Every Advisor must complete this form and submit it to SkillsUSA--Arizona. The SkillsUSA--Arizona staff will
verify receipt of this form prior to accepting registration to any conference, event, activity or meeting that
involves students.

Advisor Name:

School:

Email:

Please check to certify your agreement and compliance:

By checking the box, I agree that I have obtained a completed and signed Personal Liability & Medical Release Form for each student attending any of the following SkillsUSA--Arizona activities or any other workshops, seminars, and activities sponsored by SkillsUSA--Arizona and/or national SkillsUSA, Inc.:

► Washington Leadership Training Institute (WLTI)

► Fall Leadership Conference (FLC)

► Leadership Training Camp (LTC)

► Regional SkillsUSA Conferences (RSC)

► SkillsUSA--Arizona Championships (ASC)

► SkillsUSA Championships & NLSC

► Any other SkillsUSA--Arizona endorsed, sponsored or hosted activity, function, conference or meeting

Americans with Disabilities Act
Do you have a student who meets the ADA
requirements? If so, check box.

By checking the box, I certify that I have a student who meets the criteria specified in the Americans with Disabilities Act (ADA). We will contact you for further information.

Possession of Student Forms

By checking the box, I am also indicating that I will have the SkillsUSA--Arizona Personal Liability & Medical Release Forms in my possession for the duration of any of the above activities, including travel to and from these activities. I also understand the following:

1. SkillsUSA--Arizona will not collect the Personal Liability & Medical Release Forms prior to or
at SkillsUSA activities.

2. A signed original copy of this "State of Assurance" form should be on file at the SkillsUSA--Arizona office prior to attending a conference. Advisors should take the original copies of the students' Personal Liability & Medical Release Forms " forms with them to each event.

3. The SkillsUSA--Arizona Personal Liability & Medical Release Forms, when properly and totally completed, represents my student's and my best liability and medical protection during SkillsUSA activities.

Participation Requirement

ALL MEMBERS ARE ELIGIBLE TO PARTICIPATE IN A STATE-WIDE LEADERSHIP CONFERENCE. The SkillsUSA--Arizona Board of Directors had directed the state office that eligibility for a section (1 teacher's program) to send contestants to the SkillsUSA--Arizona Championships, in any Career Preparation contest, will be based on the section participating at the Fall Leadership Conference or Leadership Training Camp (rev. Nov. 2006)

Complete Compliance

By checking the box, I certify that I have read the above and hereby offer assurance that I understand and agree to comply with and enforce the policies stated, as indicated by my signature appearing below.

Clicking the submit button indicates your approval, compliance and acceptance of all statements and
duties listed on this form. You will receive a confirmation page displaying all information.