PRYDE FACT SHEET WHAT IS ROTARY INTERNATIONAL? Rotary is an organization of business and professional leaders united worldwide, who provide humanitarian service, encourage high ethical standards in all vocations, and help build goodwill and peace in the world. Rotary is the world s first service club, founded in Chicago, Illinois, in 1905. It now has over 1.2 million service-minded men and women belonging to nearly 34,000 Rotary clubs in virtually every nation in the world. Rotarians plan and carry out a remarkable variety of humanitarian, educational, and cultural exchange programs that touch people s lives in their local communities and our world community. WHAT IS PRYDE? The Personal Rotary Youth Development Experience is a two-day leadership conference. It is a retreat for outstanding youth to further develop their leadership skills. Sponsored by the 60 Rotary Clubs in Distinct 5330 (San Bernardino & Riverside counties), PRYDE combines training in a casual, relaxed atmosphere with social and fun time to provide a fast-paced and memorable leadership experience. WHEN AND WHERE IS PRYDE? PRYDE 2012 will be held Saturday May 5, through Sunday, May 6, 2012, at the beautiful Thousand Pines Camp and Conference Center in Crestline, California. The students will report to a designated bus pickup location on Saturday morning, May 5 for the first session. They will return Sunday afternoon, May 6. Exact details will be sent in a letter to all chosen participants. All PRYDE participants must arrive and depart on the official buses. There are no exceptions. HOW MANY WILL ATTEND PRYDE? More than 150 Seventh Grade students selected from all public and private schools within Rotary District 5330 will attend, along with 40 Rotarians and additional camp staff. WHAT ARE THE CRITERIA FOR SELECTION? Seventh grade students are selected by the local Rotary club on the basis of leadership potential, personal values, intelligence, and potential for future success. The participants must make a commitment to attend the whole weekend. They may not arrive late or leave early. HOW ARE STUDENTS SELECTED? The selection process may vary. Usually school staff members are asked to nominate seventh grade students. The sponsoring Rotary club appoints a screening committee to make the final selections. WHAT TYPE OF ACTIVITIES ARE CONDUCTED AT THE CONFERENCE? The program features several outstanding leadership speakers. These presentations are followed by discussions in small groups with trained adult discussion leaders. Recreation activities are scheduled throughout the weekend, including sports and games. Excellent food and snacks are also provided. HOW IS THE CONFERENCE SUPERVISED? The conference is supervised by an all-volunteer Rotarian staff. The staff consists of 10 staff members, 20 discussion group leaders, 15 High School Interact students, and a camp nurse. Each discussion group leader is assigned to a group of 7 to 8 students for the entire weekend. Boys and girls are housed in separate dormitories with appropriate chaperones. WHAT ARE THE COSTS TO THE PARTICIPANTS? There is no direct cost to the participants. The sponsoring Rotary Clubs pay the fee for each camper that they send. (PRYDE Form B)
May 5-6, 2012 Thousand Pines Camp, Crestline, California Student Application (Club selection process only) Selection for this conference is based on the information given on this application and an oral interview. Name Address Phone School Grade Describe a situation that demonstrates your ability to set goals and accomplish them. Describe who you want to be. Describe how the PRYDE experience would be beneficial to you. Describe how utilizing leadership or personal skills, has allowed you to make a difference. (PRYDE Form C)
May 5-6, 2012 Thousand Pines Camp, Crestline, California What to bring to camp: _ Sleeping bag _ Pillow _ Blanket _ Paper, pen, markers _Camera _ Flashlight _ Toothbrush and toothpaste _ Towels, washcloth, soap _ Comb/brush _ Medications, glasses _ Sunglasses _ Lip balm _ Hand lotion _ Cap/knit hat _ Gloves _ Non-slip shoes _ Extra socks _ Jacket/coat _ Warm weather clothing _ Cold weather clothing In case of emergency, students may be contacted through: Thousand Pines Camp and Conference Center 359 Thousand Pines Road, Crestline, CA. 92325-3288 909-338-2705 Phone 909-338-3511 Fax Messages other than for emergencies will not be accepted. (PRYDE Form D)
Rotary District 5330 May 5-6, 2012 PRYDE Registration Please print legibly Student s Name Sex Male Female Home Address Address City Zip Mailing Address (if different from Home Address) Address City Zip Telephone ( ) School Age School Grade Parent or Guardian s Name Parent or Guardian s Address Parent or Guardian s Phone (Emergency Phone)( _) Sponsoring Rotary Club Students: Please return this Registration Form and the Release Form to your sponsoring Rotary Club before March 1, 2012 Do not write below this line Bus # Cabin # Group (PRYDE Form E)
Medical & Liability Release Form (PRYDE Form F) PRYDE May 5-6, 2012 (Must be completed for all Campers) Please Print Student s Name Phone ( ) Address City Zip Emergency Contact Phone ( ) Health Questionnaire If YES to any question please provide details/information on the reverse side of this form: Yes / No Yes / No Yes / No Allergies: Heart Condition Condition Restricting Activities: Diabetes: Behavior Disorder: Physical Accommodations: Asthma: Bleeding Condition: (wheel chair, Interpreter etc.) Epilepsy: Migraine Headaches: Stomach Problems: Menstrual Problems: Tetanus Current: In the past 3 wks has your child been exposed to any infectious disease: List all medications. All medication MUST be given to the camp nurse to be dispensed. Medication Name Dosage Frequency I give the health care provider(s) at Thousand Pines permission to give over the counter medication and administer other treatment, as they deem necessary. Any exceptions please explain on the reverse side of this form. Medical Insurance Provider Policy Number Insured s Name Please complete if you do not have a medical insurance carrier. I give my permission to use my credit card in the event I have no insurance carrier. Credit Card: Visa MasterCard Credit Card # Exp Authorized Signature Medical Transportation, Activity and Photo Release I give permission to Rotary District 5330, Thousand Pines and its agents to select transportation to a medical provider who may provide proper treatment for, hospitalization of, order injections, X-ray examinations, anesthesia or surgery for my child as named above. The above named agent is authorized to make medical decisions concerning the health and welfare of my child. There are many inherent risks in a mountain camp experience. Camp activities include, but not limited to hiking, sports, games, low adventure ropes course, rock climbing and dancing. There is the possibility of risk of physical injury or harm from participating in these activities. I voluntarily elect to allow the above named to participate in activities and assume the risk of injury or harm that could result from participation. On my own behalf and that of my personal representatives and heirs, I hereby release Rotary District 5330, Thousand Pines, its officers, employees and agents from all liability from any injury or harm to my child (or minor) from participating in any activity at Thousand Pines Camp, whether the injury or harm is caused by accident or by negligence of Thousand Pines or otherwise. I hereby agree that Rotary District 5330 or Thousand Pines may use any type of audio and/or visual records of this program for its promotional and/or commercial purposes without compensation to me. I have read, understand, and agree to the above. My child may participate in any camp activity any except as noted on the reverse side of this form. See Back of Form Check box Parent/Guardian Signature: _X Date
Code of Conduct You have been selected for this Personal Rotary Youth Development Experience because you have potential to be a leader. This camp will enhance your personal abilities, and offer you the opportunity to meet and share ideas with other leaders. Our speakers, activities, and discussion groups will provide you with many positive and helpful approaches to personal growth. Rotarians are looking forward to sharing the PRYDE experience with you. Please attend all assigned activities. Behave in a manner your parents and sponsoring Rotarians would be proud of. Should PRYDE officials consider your conduct unacceptable at any time, your parents/guardians will be contacted to remove you from camp. We want next year s PRYDE weekend to be welcome at Thousand Pines Camp. Please leave the facilities and grounds as clean as, or cleaner than when you arrived. Follow the requests of camp staff. Report damage or breakage immediately to your Group Leader or Cabin Monitor. You are encouraged to approach any Rotarian or camp staff for assistance at any time. Procedures and Rules General: 1. You have made a commitment to attend PRYDE from Saturday morning to Sunday afternoon. If a conflict arises, and you can t attend the whole weekend, contact your sponsoring Rotary Club immediately. 2. Transportation is provided to and from camp. No private transportation is allowed. 3. Help us maintain camp security by wearing your nametag at all times. 4. If any person is injured or becomes ill, do not move him/her. Immediately contact your Group Leader, Cabin Monitor or other staff. 5. If you take medications, whether prescribed or over-the-counter, take them to the Camp Nurse, and inform your Group Leader and Cabin Monitor. Keep medications in original containers. 6. Tobacco, alcoholic beverages, and illegal drugs are not permitted. Any violation will lead to dismissal from camp. 7. Remain in camp. Do not leave the camp boundaries. 8. Treat everyone with respect. Discriminatory, foul or abusive language will not be tolerated. Avoid physical violence or threats. Any sexual or lewd misconduct is not acceptable. Any of these behaviors may result in removal from camp. 9. Use of cell phones and other electronic devices is not permitted during meetings, activities or meals. Cabins: 1. You will be assigned to a room with other campers and a Rotarian Cabin Monitor. Select your bed and stow your sleeping bag and other personal gear in the space provided. Respect everyone s belongings and space. 2. Store your gear out of sight. Some cabins are used for small group meetings. 3. Work with your Cabin Monitor to schedule use of bathrooms and showers. 4. You will not be able to return to your cabin except at specific times in the schedule. Leave in morning prepared for weather, with your folders. 5. Be in your cabin by Lights-Out. Talking is allowed as long as it does not disturb others in your room. 6. Please remain in your room throughout the night. Security forces will patrol the camp during the night. 7. There are separate cabin areas for males and females. Do not enter a room or cabin that is not assigned to you. Males are not allowed in female cabin areas, and vice versa. Small Group: 1. You will be assigned to a small discussion group. A Rotarian will be your group leader. You will meet your group in Jensen Chapel and participate in discussion groups, meetings, activities and meals as a group throughout camp. 2. Confidentiality is important in the Discussion Group. Anything that is shared there shall remain there, unless it is a topic that the Discussion Group Leader is mandated by law to report, such as suicide or abuse issues. 3. Be on time to all meetings and remain in the meeting according to the camp schedule. Dining: 1. Sit with your small group during all meals. 2. The Interactors and camp staff will explain mealtime procedures. Listen carefully and follow their directions. You may obtain seconds when everyone else has been served. 3. Assist your group in cleaning up after meals. I have read the Code of Conduct and agree to honor it. Student s name Student s Signature Parent s Signature Sponsoring Rotary Club X X (PRYDE Form G)
PRYDE Club Reservation Cover Sheet To be submitted with student registration packets to Registration Chair, Jeff Williams 3297 Russell Street, Riverside, CA. 92501-2248 Due Date: March 15, 2012 5330pdg@gmail.com Rotary Club Club Contact Email Phone School Forms to be returned PRYDE Registration E Medical & Liability Release F Code of Conduct Form G Signatures Required None Parent/Guardian Student First Name Last Name Address City/Zip Gender (M or F) (Camper/Alternate)