Rotary Club Information Packet. For. RYLA Camp Rotary International District Steve Cook, District Governor

Transcription

1 Rotary Club Information Packet For RYLA Camp 2012 Rotary International District 7610 Steve Cook, District Governor Send correspondence to: RYLA Chairperson Dan Radtke 9083 Park Ave Manassas, VA

2 RYLA 2012 TABLE OF CONTENTS General Information Club Responsibilities Timetable Club Requirement Check List Applications & Required Forms Sponsorship Opportunities Sample News Release Map to Camp Happyland (Camp 5) Items Campers Should Bring to Camp Counselor Application 2

3 General Information Rotary clubs around the world have been dedicated for over sixty-five years to the development and enrichment of leadership skills in youth. From its inception in Australia to the United States to Russia, Rotarians have given countless hours towards developing and producing an experience that will change the lives of the young people who attend in a very positive way. PURPOSE: To provide outstanding student leaders an opportunity to expand and hone their leadership skills during a scholarship program. DATE: Sep 21 to 23, 2012 COST: PLACE: OPENINGS: REFUND: RYLA CHAIR: $ per attendee Prince William Forest Park (National Park Service) Camp 5 (Camp Happyland) Hwy 619 Prince William County, VA 50 campers Camp RYLA will not make refunds on scholarships that have been awarded and funds rendered. This is why we recommend that you have one or more alternate campers selected. Dan Radtke 9083 Park Ave Manassas, VA Cell: (703) danradtke@earthlink.net 3

4 Club Responsibilities The Board of Directors, Club President and the appointed RYLA representative need to determine the schools to approach and administrative contacts. RYLA campers will be students who are juniors or seniors and on a space available, sophomores. The ideal candidate will be a boy or girl who has proven his/her leadership skills academically and with his/her efforts to serve the school community and/or the community at large. Please select candidates representative of the ethnicity and cultural diversity of your community with an eye towards gender balance. It is also suggested that you give preference to members of the high schools Interact Club. Each Rotary Club should solicit the help of principals, guidance counselors, and other key personnel to assist in the selection of prospects for a Camp RYLA scholarship. Students who are striving to attend the better colleges and universities like having an activity such as Camp RYLA on their resumes in hopes of influencing the selection boards. The RYLA committee recommends you choose two or more Rotarians to conduct short interviews of prospective candidates to select the finalist(s) if time allows. The next page has a few sample interview questions to assist those who will handle the process. Send the official RYLA application, if not already completed, to the applicants with a date and place for interviews. A realistic club goal would be to identify the officers of the sponsored Interact Club. Have selected attendee(s) and alternate(s) take the applications and consent forms home to complete and have parents/guardian sign the Student Applications and the Parental Consent Forms. Submit the official applications with the required signatures and a photograph attached, the medical form, liability form, club form, and tuition to the district by Sept 17, The Rotarian assigned to be the club RYLA representative is to arrange transportation by Rotarians, parents, or guardians, to and from the event. No exceptions unless approved by the District Chairman. Liability issues make it vital that no student is allowed to drive a personal vehicle to the camp (or friends, peers, boyfriends, girlfriends, etc.) Please notify the District Chairman of transportation arrangements for your camper(s). Students are to return to the sponsoring club to make their RYLA presentation (after they return from the camp) at a regularly scheduled Rotary meeting as soon as possible. 4

5 RYLA 2012 Club Requirement Checklist (attach required club paperwork behind this checklist) Rotary Club of RYLA Representative Mailing Address City, State, Zip Telephone Number Club RYLA representative information previously submitted to the district chairman. Official application signed by parents, with two Rotarian signatures, and a photograph for both the scholarship recipient and alternate. Official medical/parental consent form completed and signed by parents. (and physician, if applicable). Official RYLA Camp liability form completed and signed by parents. Fully completed and signed club form by person who provides the transportation if not your Rotary Club s RYLA representative. Scholarship tuition for attendees or open scholarships. Optional program and/or material sponsorship opportunities indicated and with correlating funds. Send originals and checks to: Dan Radtke RYLA Chairman 9083 Park Ave Manassas, VA

6 RYLA STUDENT APPLICATION Participant Alternate Filled out by Sponsoring Rotary Club Only Name of Rotary Club: Club RYLA Chairman: Phone #: PHOTO MUST BE ATTACHED High School Being Represented: I. PLEASE TYPE OR PRINT CLEARLY Male: Full Name: Current Age: Current Grade: Female: Preferred Name: Date of Birth: T-Shirt Size: M L XL XXL Address: City & Zip Code: Address: Cumulative Grade Point Average: Home Phone:( ) Parent s Work Phone:( ) ACADEMIC ACCOMPLISHMENTS: (Honor Roll, Awards, Accelerated/Special Classes) OTHER SCHOOL ACTIVITIES & RECOGNITIONS: (Positions held and responsibilities undertaken) OUTSIDE SCHOOL INTERESTS, HOBBIES, AND RECREATION: WORK EXPERIENCE: (Summers/After School) If additional space is needed, then attach a separate sheet of paper Rotarian Interviewer Rotarian Interviewer ALL APPLICATIONS MUST BE SIGNED AND HAVE A CURRENT PHOTO ATTACHED. I agree to allow the RYLA medical staff to dispense any non-prescription medication (aspirin, Tylenol, cough syrup, etc.) to my child, if needed. IN CASE OF EMERGENCY, I understand every effort will be made to contact me. In the event, I cannot be reached, I hereby give permission to the physician, selected by the RYLA directors, to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery for my child, as named above. PARENT S SIGNATURE DATE PARENT S NAME (PLEASE PRINT) 6

7 Please print legibly or type Rotary Youth Leadership Award Camp Sep 21 23rd, 2012 II. Parental Consent for Participation and Medical Treatment Permission Form District 7610, Rotary International Complete all items. Parent or Guardian must sign. Student s Name I want my name badge to read: (Nickname) Address S ex DOB & Age City State Zip Code Parent s or Guardian s Name Parent s or Guardian s Address (if different from student s address) Alternate Contact s Name Name of Medical Insurance Company Name of Primary Insured Physician s Name Sponsoring Rotary Club Name & Contact Rotarian s Name Parent s or Guardian s Work Phone Number with Area Code Parent s or Guardian s Home Phone Number with Area Code Alternate Contact s Phone Number with Area Code Policy Number Medical Insurance Phone Number with Area Code Physician s Phone Number with Area Code Contact Rotarian Phone Number with Area Code Please list any medical problems, allergies, or medical conditions that we should be aware of - Please list any prescription medications, with dosage and frequency, that the student is using or might need - PARENTAL AUTHORIZATION: I do voluntarily consent to said minor s participation in all activities of the Rotary Youth Leadership Awards camp to be held at Camp 5, Happyland, at Prince William Forest Park, Prince William County, VA on Sep 21-23, I assume responsibility for any medical or treatment fees or costs incurred directly or indirectly because of said minor s participation. I also authorize the representative(s) of Rotary International to arrange for professional care and treatment in case of a medical emergency. I hereby give my permission to the physician selected by the Rotarian(s) to hospitalize, secure professional treatment for and/or to order injections, anesthesia, and/or surgery for the minor name above. I certify that the above name participant will not be 18 years old by Sep 21, I take full responsibility for any valuable the above name participant takes to this camp. A photocopy of this form is as valid as the original. Print Parent/Guardian Name Signature Date RELEASE, ASSUMPTIONS of RISK and AGREEMENT TO HOLD HARMLESS In consideration of the sponsoring Rotary Club, Rotary International District 7610, Rotary International, I permit my child to participate in the RYLA Leadership Camp and to engage in all said activities related to the camp s activities. I hereby assume the risk associated with participation and agree to hold the Rotary Club, Rotary International District 7610, Rotary International, its committees, employees, agents, representatives, and volunteers harmless from any and all liabilities, actions, causes of action, claims or demand of any kind and nature whatsoever that may arise by or in connection with my child s participation in any activities related to the RYLA camp. The terms here shall serve as a Release and the assumption of the risk for my child, his or her heirs, estate, executor, administrator, and assignees as well as members of my family. I grant Rotary permission to use the image of the above named minor for educational and promotional purposes. In addition, Rotary may contact the named minor regarding other Rotary programs including, but not limited to, Interact, Rotoract, speech contest, musical performance contest, and scholarship opportunities. Print Student s Name Print Parent/Guardian s Name Signature Date 7

8 RYLA 2012 CLUB FORM RYLA Camp: Sep 21-23, 2012 at Camp Happyland/Prince William Forest Park The Rotary Club of will sponsor participant(s) at a cost of $250 per participant for a cost (# of participants x $250.00) of $. We also elect to sponsor or share in the sponsoring of the item(s) ( ) at a cost of $. Check # is attached for a total RYLA sponsorship of $. III. Rotary Club RYLA Representative Contact Information Name Work Phone ( ) Address Home Phone ( ) City Zip Code Fax Phone ( ) Mobile (Cell) Phone ( ) I will hereby assist in the selection of students who embody the leadership qualities as described in the Rotary Club RYLA Packet. I will communicate to the selected participant and alternate all pertinent information (including my club s commitment to transport them to and from RYLA) in a timely manner, once their acceptance is confirmed by the district. I understand all submitted applications are subject to review and acceptance by the RYLA District Chairman and/or District Governor. Signed: Date: IV. Transportation to the camp will be furnished by: Name Work Phone ( ) Address Home Phone ( ) City State Zip Cell Phone ( ) Relationship to camper (or indicate Rotarian) Send this form with your club s check attached (payable to District 7610 RYLA Camp) to: Dan Radtke RYLA Chairman 9083 Park Avenue Manassas, VA DEADLINE FOR APPLICATIONS IS Sept 17,

9 RYLA 2012 Sponsorship Opportunities Open Scholarships (each) $ Howdy Pizza Party - Friday evening, Sep 21, Ice Cream Social Saturday evening, Sep 23, Adios Barbeque - Sunday afternoon, Sep 23, Breaks soft drinks, bottled water, snacks for 5 breaks Special Needs Registered Nurse(s) or EMT s for Sep 21-23, 2012 Adult Men and Women to serve as camp counselors (preferably Rotarians)* Rotary Clubs wishing to sponsor any of the items listed at the top of this page should contact Dan Radtke at (703) Rotary Clubs may elect to join one or more Rotary Clubs to sponsor an event or activity. RYLA will accept donations of any size toward the items listed above. 9

10 Sample RYLA News Release (Include photo depicting action between two or more RYLA attendees or pictures taken when the campers visit your club.) Contact: (Your name and telephone number) Rotary Program Introduces Youth to Concepts of Leadership (City), (State) and (Date) More than 40 young people entering their senior year this Fall in northern Virginia schools will be learning the various aspects of leadership in their home and school, the workplace, their community, and internationally during a weekend Rotary sponsored event for youth. Known throughout the world as Rotary Youth Leadership Awards (RYLA), the program provides education and training for young people with outstanding leadership potential. Those chosen to participate in RYLA will hear informational presentations and participate in such activities as team building tasks, goal-setting activities, fundamentals of leadership, ethics of leadership, time management, conflict resolution, and community service all present through diversity exercises. RYLA participants receive training from successful professionals with special emphasis on the importance of ethics and community service. These young adults often become leaders in their schools, communities, and professional endeavors. The Rotary Club of ( ) is part of Rotary International s global network of more than 34,000 clubs in over 200 countries and Rotary District 7610 locally. Rotary International consists of 1.5 million professional men and women who are civic leaders who volunteer to improve the quality of life in their homes and world communities. Rotary clubs support programs that address today s most critical issues including violence, drug abuse, hunger, the environment, literacy, youth development, and international exchange. 10

11 Directions to Camp 5 Happyland, RYLA Sep 28, 2012 From I-95. Take exit 150B (Hwy 619) and drive west/northwest on Rt 619 for 4.3 miles to Mawavi Drive and then right on Happyland Drive. There will be a directional arrow there with the RYLA logo. Follow this road and the RYLA directional arrows to the registration cabin. If you have any problems, call Dan Radtke on his cell phone at What to bring to Camp RYLA 11

12 Sleeping bag, pillow Toiletries & soap Bath towel & washcloth Warm jacket Flashlight & extra batteries Gloves & warm hat Travel alarm clock Lip balm & sunglasses Jeans, sweats or slacks Water resistant walking shoes & rain gear Inexpensive camera & film Warm sleepwear Long-sleeved shirts Pen or pencil Changes of underwear Sweaters and/or sweatshirts Several pair of socks Insect repellant A sense of humor!! Pack all of your gear in a duffel bag or other suitable luggage that you can carry (you may have to tote it up to 100 yards). What NOT to bring to R.Y.L.A.! Alcohol Cell Phones or Pagers Cigarettes Firearms Fireworks Illegal Drugs Matches or lighters Radios or Walkmans Sheath knives Slingshots Televisions Valuables/Jewelry/etc. Video games Virtual Pets 12

13 RYLA 2012 COUNSELOR APPLICATION Mark Your Calendar! RYLA, Sept 21-23, 2012 Name PHOTO MUST BE ATTACHED Address Telephone Number Full Name Date of Birth T-Shirt Address City Zip Phone Preferred Name at Camp Years as Rotarian: Rotary Affiliation Briefly state why you would like to serve as a RYLA Counselor Do you have any previous experience with camping and/or counselor experience? If yes, then please describe Counselors will be needed at the camp at 3:00 p.m. on Sep 21, 2012 to assist with set up and preparation for camper registration. Room and board plus RYLA shirts are provided during the program. Please call Dan Radtke (703) if you have any questions. Signature: Date: (Please send ASAP to Dan Radtke, 9083 Park Avenue, Manassas, VA 20120) 13