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Virtual Pre Seminar Materials

Note: Your privacy is very important to us. To better serve you, the form information you enter is recorded in real time.

Dear Participant,

Congratulations! You have been selected to represent your high school at the Hugh O’Brian Youth Leadership (HOBY) Seminar. You were chosen because of the outstanding leadership potential you have demonstrated in school and community activities. The Virtual HOBY West Virginia Leadership Seminar will take place August 1-2, 2020. The event will be hosted via HOBY Connect, through the HOBY Website where you will be joined by other “HOBY Ambassadors” to enjoy a unique learning experience. We will present multiple viewpoints on important issues and encourage you to think critically about leadership, and also begin to identify your own particular leadership strengths. The seminar will be an enjoyable experience in a dynamic workshop environment. What you get out of the seminar will correlate directly with your level of participation in the activities – come prepared to interact! Enclosed, please find the HOBY pre-seminar materials and program details. Please ensure that you thoroughly review and complete all of the forms with your parent or guardian. You must complete the following forms by July 16, 2020.

  1. Acknowledgment 
  2. Virtual Seminar Resources
  3. College & University List
  4. Frequently Asked Questions
  5. Participant Confirmation Form
  6. Medical Information
  7. Notice of Privacy Practices
  8. Consent & Acknowledgement of Risk
  9. Virtual Seminar Ambassador Rules & Regulations

If you have any questions or if you find you will not be able to attend the virtual seminar, please contact me at 240-626-1728. Should you have any problems logging in to the platform on the day of the seminar, please call 240-513-0001. We are delighted to offer you this opportunity and look forward to having you attend our West Virginia Leadership Seminar.

Sincerely,

Amber Kelley

Director of Recruitment

amber.kelley@hobywv.org

240-626-1728 - Please leave a message and I will return your call within 24 hours.

Acknowledgement

Please be advised that these HOBY Pre-Seminar Materials are extensive and will take you an estimated 30-45 minutes to complete. It contains a participant confirmation, consent and acknowledgment of risk, virtual seminar resources, notification of privacy practices, as well as additional necessary information. Collection of this data is done for all HOBY participants. All data is maintained securely and is protected by HIPAA law.

This form set has multiple places that will require a parent or guardian electronic signature. You will want them present as you complete the forms.


Virtual Seminar Resources

What technology device will the ambassador use for the virtual seminar?*
Does the ambassador have access to internet?*
Does the ambassador have a quiet, comfortable place to participate in the virtual seminar? *
Does the ambassador have access to a microphone and/or headphones?*

Medical Information

College and University List

Congratulations on your student’s selection to attend HOBY!

Be sure your child adds HOBY to their college applications to help them stand out in a crowd. Colleges and Universities around the country are interested in students with HOBY experience, and some even offer scholarships specifically for HOBY alumni. If, for some reason, you would not like your student’s information shared with Colleges and Universities, please check the appropriate box below.


*

Answers to Frequently Asked Questions from Students and Parents

  • How do I access the Virtual Seminar?  You will receive a link, by email, 72 hours prior to the start of the Virtual Leadership Seminar.
  • When will the seminar be held? Seminar participants may log in 08:30 a.m. on 08/01/2020.The seminar will begin with Ambassador Orientation on 08/01/2020 9:00 a.m. and conclude with Closing Ceremonies on 04:00 p.m 08/02/2020.You must be present for the entire seminar.
  • What kind of program is planned? A high-quality experience while expanding your leadership learning. Our virtual Leadership Seminar will feature many of the same elements as our in-person programs. You will hear from a wide variety of speakers including West Virginia storytellers and writers, Rainn Wilson, Founder of SoulPancake, and others. You'll also have fun group activities and interactive sessions with other students and HOBY volunteers. The program will not promote any specific political party, religion, or way of thinking; but is designed to develop critical thinking skills by actively involving participants in discussions and informal debate. During the seminar, you will be asked to undertake a community service project(s) involving at least 100 hours during the year following your seminar, to make a difference in your school, community, place of worship, or another environment where you see a need.
  • Will I need to download any software or documents for the seminar? No.
  • Who pays for the seminar? Your school or parent has paid a Registration Fee. 
  • What should I wear at the seminar? Wear a comfortable t-shirt representing your school or community.
  • What if I am unable to attend the seminar? If circumstances arise that prevent you from attending the entire seminar, we would like to allow another student to attend. Please notify your school who selected you, and follow up with a call to Amber Kelley, 240-626-1728.
  • Who may I contact should I have additional questions? Additional questions or concerns should be directed to Zachary Morris, 304-389-7833, zach.morris@hobywv.org
  • What action should I take now? With your parent or guardian, carefully review, complete, and sign the forms in this set by 7/24/2020.

You may download the Frequently Asked Questions document here.

Participant Confirmation Form

Name*
Gender*
Home Address*

Parent Contact Information

Parent/Guardian 1*
Parent/Guardian 2

It is very important that when giving your email address you know the following:


You can not use a school based email account (it will not let us send you emails since we are not within your school network)

The email address given needs to match the one that you will use to set up your free Zoom account (or if you already have a zoom account utilize that email address if you wish)

Instructions on how to set up your free Zoom Account can be found here.

Notice of Privacy Practices

WE PROVIDE THIS NOTICE TO DESCRIBE HOW MEDICAL INFORMATION ABOUT YOUR CHILD OR DEPENDENT MAY BE USED AND DISCLOSED. PLEASE REVIEW THE BELOW INFORMATION CAREFULLY AND IF YOU AGREE, PLEASE EXECUTE THE ATTACHED AUTHORIZATION.

 

We understand the importance of privacy and are committed to maintaining the confidentiality of your child or dependent’s medical information. We may preserve the medical disclosure information (“medical information”) concerning your child or dependent provided by you to HOBY for up to seven years. We use and retain these records to provide or enable health care providers to provide quality medical care to your child or dependent in the event of an emergency. This notice describes how we may use and disclose your child or dependent’s medical information. It also describes your rights, the rights of your child or dependent, and our legal obligations with respect to your child or dependent’s medical information.

 

A. How HOBY May Use Or Disclose Your Child Or Dependent’s Medical Information

HOBY collects health information about your minor child or dependent and stores it in a file and on a computer. These files are the property of HOBY, but the information belongs to you and your child or dependent. The law permits us to use or disclose your child or dependent’s medical information for the following purposes:

1. Treatment. In the event of an emergency, we will provide medical information about your child or dependent to the appropriate health care provider to provide for the medical care of your child or dependent. We may also disclose medical information to members of your family or others who can help your child or dependent if you are not available.

2. Awareness. We may also provide medical information about your child or dependent to HOBY employees and/or volunteers to the extent necessary.

3. Alumni Activities. We may provide medical information about your child or dependent to HOBY employees and/or volunteers in connection with alumni activities or events in which your child or dependent may be a participant.

4. Limited Disclosure. We will limit the use and disclose of medical information about your child or dependent as detailed below.

B. When HOBY May Not Use Or Disclose Medical Information

Except as described in this Notice of Privacy Practices, HOBY will not use or disclose health information which identifies your child or dependent without your written authorization.

C. Your Health Information Rights

1. Request for Special Privacy Protections. You have the right to request restrictions on certain uses and disclosures of your health information by way of a written request specifying what information you want to limit and what limitations on our use or disclosure of that information you wish to have imposed. We reserve the right to accept or reject your request and will notify you of our decision.

2. Copy of Notice. You have a right to a paper copy of this Notice of Privacy Practices.

If you would like to have a more detailed explanation of these rights, or if you would like to exercise one or more of these rights, contact Hugh O’Brian Youth Leadership at 818-851-3980.

D. Changes to this Notice of Privacy Practices

We reserve the right to amend this Notice of Privacy Practices at any time in the future. Until such amendment is made, we are required by law to comply with this Notice. After an amendment is made, the revised Notice of Privacy Protections will apply to all protected health information that we maintain, regardless of when it was created or received.

E. Questions or Complaints

Questions or complaints about this Notice of Privacy or how HOBY maintains the medical information of your child or dependent should be directed to Hugh O’Brian Youth Leadership at 818-851-3980.

Click here to download a copy of the Notice of Privacy Practices.

By initialing here, I hereby acknowledge the I have received a copy of the Notice of Privacy Practices.
By initialing here, I hereby acknowledge the I have received a copy of the Notice of Privacy Practices.

Consent & Acknowledgement of Risk

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IN CONSIDERATION of the right to attend and participate in the Activities described above, the Participant (and, if the Participant is a minor, his or her parent or legal guardian) hereby:

1) Agrees to abide by all rules and regulations established by Hugh O’Brian Youth Leadership (HOBY);

2) Authorizes HOBY or any of its agents to provide, obtain, or authorize any reasonable incidental and/or emergency medical treatment for the Participant, in the event of the Participant’s illness, injury, or incapacity, and hereby accepts the responsibility to pay for such treatment;

3) Grants to HOBY the right to use in perpetuity Participant’s name, voice, likeness, biographical information, verbal or written quotes in any and all media, including, but not limited to, print, internet, social media, electronic, or broadcast.   Participant relinquishes and gives to HOBY all rights, title, and interest in any finished advertisements, reproductions, and original writing, video, photograph, likeness and/or recording created during participation in the Activities.  Participant hereby waives any right to any royalties or other compensation for the use of the original writing, video, photograph, likeness and/or recording taken based on the permission granted above, including, without limitation, rights related to publicity or commercial appropriation of likeness.  Participant hereby waives any right to inspect, review and/or approve any original writing, video, photograph, likeness and/or recording or use of such video, photograph, likeness and/or recording.

4) Acknowledges that there is an element of risk involved in any activity and certifies that Participant is physically, mentally, and emotionally capable of attending and participating in the Activities.  Participant assumes all risk of and financial responsibility for any loss or injury to the Participant or others that may occur as a result of the Participant’s negligence or misconduct, and indemnifies, defends, and holds HOBY harmless from and against any and all costs, claims, demands, charges, liabilities, obligations, judgments, executions, costs of the suit and actual attorneys’ fees incurred or suffered by HOBY as a result of, or arising out of, the Participant’s negligence or misconduct;

5) Agrees to immediately advise in writing the person in charge of the HOBY event and/or HOBY International of any injury, illness, or loss that occurs to the Participant during the event.This Consent and Acknowledgment of Risk shall not be amended, supplemented, or abrogated without the written consent of HOBY’s International Office in Westlake Village, California.  The Participant (and, if the participant is a minor, his or her parent or legal guardian) has read this Consent and Acknowledgment of Risk, and understands its contents.

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Date*
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Date*

HOBY Virtual Seminar Ambassador Rules and Regulations

So that this virtual seminar may be conducted as smoothly and efficiently as possible, we ask that you observe the following rules. Any participant who does not abide by these rules and regulations will be dismissed from further participation. Your parents and school will be notified of any violation of the Rules and Regulations or dismissal from the program.

1.) You must make a commitment to stay for the entire seminar. If you have a scheduling issue, we strongly suggest offering the weekend to your school’s alternate.

2.) You are expected to be on time for all seminar functions and attend all scheduled activities.

3.) In case of emergency, please inform your group facilitator or Leadership Seminar Chair.

4.) If you must leave the room, please turn off your video.

5.) If you are not speaking, please mute your microphone to reduce background noise.

6.) The name you choose to show on Zoom should match the name on your registration.

7.) Be respectful in all small group and large group chats that you participate in. 

8.) The following attire is not permitted at any time: strapless/tube tops, tops with spaghetti straps, tank tops, bare midriffs, exposure of undergarments, short shorts, mini skirts, excessively tight clothing, clothing with profane or offensive language or graphics, torn clothing, and clothing with holes.

9.) Conduct yourself with the highest level of decorum, morals, ethics, and conduct appropriate for a chosen representative of your school.

10.) Cyber-bullying will not be tolerated. 

Click here to download a copy of the Ambassador Rules and Regulations.

By signing below, and by my initials and signature on all preceding parts of this form, I verify and acknowledge that:

  • I have read the Virtual Seminar Resources;
  • I have read and understand the Frequently Asked Questions document;
  • All information provided in the Medical Information Notice;
  • I have received a copy of the Notice of Privacy Practices;
  • Consent & Acknowledgement of Risk;
  • I have read and agree to the Virtual Seminar Ambassador Rules and Regulations.
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Date*
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Date*

HOBY WV Talent Show

Description Area

Would you like to participate in the Talent Show?*
  • Please upload a video of your act for full approval by 7/27/2020 for full approval of your act, if no video (or audio if a monologue or vocal) to:
  • Link:
  • Using Password:
    • HOBYWestVirginia2020!
  • Download Instruction Sheet (to be used later)
  • Or email Admin@hobywv.org if you have questions.


Any acts not submitted for approval will not be allowed to participate in the Talent Show.

By signing below, and by my initials and signature on all preceding parts of this form, I verify and acknowledge that my act complies with the following:

  • The Virtual Seminar Resources;
  • Consent & Acknowledgement of Risk;
  • The Virtual Seminar Ambassador Rules and Regulations.
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Date*
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