New England Student Leadership Conference
July 16-19, 2019
 Worcester State University


Please click here for the conference information packet


To submit an application to represent your local state association at this conference, please complete this online application. 
Contact information for each participating state association can be found in the conference information packet. 

If you are ready to submit the application, you will need the following information:

  • Your parent/guardian must complete this online application or be present while you apply and must sign and mail your printed permission form (emailed upon completion of online application).
  • Medical and insurance information
  • A registration check payable to your local state association in the amount of $275 to be mailed immediately after applying.

When you are ready to apply, please click “Next” below!

Which association are you from?*
Student Name*
Student Home Address*
Based on men's sizing


Parent/Guardian Name*
Add/view additional parent/guardian
Parent/Guardian Name*
Emergency Contact (Other than Parent/Guardian)*
School Principal*

Terms & Conditions


If selected as one of my state's delegates, I agree to attend the New England Leadership Conference, July 16-19, 2019

By checking this box, you are agreeing to the terms and conditions as stated above.*
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Type Student Name
Date*
Use your mouse or finger to draw your signature above
Type Parent/Guardian Name
Date*

Student Name*
Date of Birth*
Student Home Address*


Parent/Guardian Name*
Add/view Additional parent/guardian
Parent/Guardian Name*
Emergency Contact (Other than Parent/Guardian)*
Does the student have any special physical needs?*
Does the student have any special dietary needs and/or food allergies?*
Does the student have any life threatening allergies?*
Is this student allergic to any medications? (penicillin, antibiotics, pain medications, etc.):*
Does the student carry an Epi-Pen?*
Is the student allergic to bee stings?*
Does the student have permission to take Antihistamines?*
Does the student have permission to take Ibuprofen?*
Does the student have permission to take Acetaminophen (Tylenol)?*
Does the student have permission to self-administer his/her own medications?*

Please type N/A if there are none to report.

Terms & Conditions


*I hereby give permission for the above named student to be treated by a physician or licensed nurse

at a hospital or on the scene in the event of a medical emergency.

By checking this box, you are agreeing to the terms and conditions as stated above.*
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Type Parent/Guardian Name
Date*

I, the undersigned student leader, do hereby agree:

  • 1.To abide by all the rules and regulations set forth by the sponsoring state associations, the Adult Delegates, and all adult supervisors.
  • 2.To waive and release any and all rights and claims for any damages I may have against the sponsoring state associations, and any other employee of the state associations, for any injuries arising from my participation in this activity.
  • 3.To accept responsibility for my behavior so that it does not reflect discredit on my school, my state association, or myself.
  • 4.To use no tobacco, alcohol or illegal drugs at the conference.
  • 5.To treat all student and adult delegates, college and adult facilitators, conference staff, state association staff, speakers, and host site staff with respect and dignity.

I understand that if I break any of the rules of the conference that I will be sent home immediately at my own expense, after the conference staff have made arrangements with my parent/legal guardian.

Student Name*
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Type Student Name
Date*

I, the parent/guardian of the above signed student, understand the obligations accepted by my son/daughter as outlined above and give my consent for his/her participation in the 2019 New England Student Leadership Conference. I do further release the sponsoring state associations, sponsors of this conference, and any other employee of said organizations from any claim for damages incurred by the said student that might be a direct or indirect outgrowth of his/her participation in this conference

Use your mouse or finger to draw your signature above
Type Parent/Guardian Name
Date*
Home Address*
By checking this box, you are agreeing to the terms and conditions as stated above.*

(the “Agreement”) For the New England Student Leadership Conference, July 16-19, 2019 (the “Conference”)


In consideration for being permitted to participate in the New England Student Leadership Conference, each of the undersigned, for him or herself, his or her child, his/her personal representatives, heirs, next of kin, acknowledges and agrees and represents that he/she agrees to:


 Consent to the undersigned Student Delegate’s participation in the New England Student Leadership Conference, a voluntary activity, and do forever RELEASE, acquit, discharge, and covenant to hold harmless the participating state associations, any and all sponsors of the Conference, their subsidiaries, parents, affiliates, officers, directors, agents and representatives, Conference promoters, participants, venue operators and owners, city officials, competitors, technicians, and any persons in any restricted area, lessees of the premises used to conduct the Conference, collectively referred to “releasees” from any and all actions, causes of action and claims on account of, or in any way growing out of, directly or indirectly, all known and unknown personal injuries or property damage which I may now or hereafter have or may hereafter may acquire, resulting from his/her participation in the Conference. 


AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releasees and each of them from any loss, liability, damage, or cost they may incur due to the presence of the undersigned in or upon the restricted areas or in any way competing, officiating, observing, or working for, or for any purpose participating in the Conference and whether caused by the negligence of the releasees or otherwise.


ASSUME FULL RESPONSIBILITY FOR ANY RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE due to the negligence of releasees or otherwise while in or upon restricted areas and/or while participating, observing, working for, or for any purpose participating in the Conference. EACH OF THE UNDERSIGNED EXPRESSLY ACKNOWLEDGES AND AGREES THAT THE ACTIVITIES OF THE Conference are dangerous and involve the risk of serious injury and/or property damage. EACH OF THE UNDERSIGNED further expressly agrees that the foregoing release, waiver, and indemnity agreement portion thereof is intended to be as broad and inclusive as is permitted and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.


THE UNDERSIGNED hereby grants permission to the participating state associations 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 participating state associations, in its sole discretion deems necessary. This includes the posting of such photographs, recordings, or other media representation of myself, on any website, or licensing others to do so in their promotional materials or websites.


I affirm that as parent and student delegate, we have read this Release and Waiver of Liability and Indemnity Agreement and that we understand the contents of this form. We understand that the student delegate’s participation in this Conference is voluntary and we are free to choose not to participate in said Conference. By signing this form, we affirm the student delegate’s participation in the Conference with full knowledge that the releasees will not be liable for personal injuries and property damage that the student delegate or parent may suffer in voluntary participation in the Conference.


NOTICE: BY SIGNING THIS RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, RELEASEOR IS AGREEING TO HAVE ANY CLAIM DECIDED BY NEUTRAL ARBITRATION AND IS GIVING UP THE RIGHT TO A JURY OR COURT TRIAL. THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no oral representation, statements or inducements apart from the foregoing written agreement have been made.

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Type Student Name
Date*
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Type Legal Parent/Guardian Name
Date*
By checking this box, you are agreeing to the terms and conditions as stated above.*
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