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RYLA 2019 Application Form
SECTION 1. CONTACT DETAILS
Name *
Your answer
Email *
Your answer
Phone number *
Your answer
Address *
Your answer
Date Of Birth *
MM
/
DD
/
YYYY
Gender *
SECTION 2. ABOUT YOU
Maximum 100 words per answer in this section
What is your highest level of completed education? *
Your answer
Tell us about the sort of person you are, what makes you tick, what you are passionate about? *
Your answer
During the 6 days you will be interacting with approximately 30+ other participants. Program content is varied and the program schedule involves long days, including lecture-style sessions, interactive activities and periods of independent reflection time. Throughout the program you can expect to have your own views and opinions challenged. How will you adapt to this environment? *
Your answer
Crucial component of the RYLA Program is ‘time away’ from everyday life.There is no access to Email/Internet or TV, and no mobile service. Phones will not be able to be brought into the program space. Participants who rely on their mobile phone as a watch will need to rely on the clocks on the wall for the week. How will you cope? *
Too easy
Noooooooo, don't make me do it
Will you be able to attend all 6 days of the conference *
To attain your Cert IV in Business you will be required to do the following: Attend and engage in all 6 days of the conference in December, Complete 20 hours of voluntary contribution to the community in Rotary or Rotaract, Attend at least 1 Rotary Club meeting prior to the conference, Attend at least 1 meeting after the conference and make a presentation of your RYLA experience, Meet with RYLA leaders before and after conference to complete assessment interviews as a recognition of prior learning, Provide your CV, Complete a self-assessment document and other relevant documents (provided by us), Ask a workplace supervisor, sporting coach or community leader that has a substantial knowledge of you to complete the self-assessment document. *
SECTION THREE: SPECIAL NEEDS & MEDICAL DETAILS
Where possible, RYLA seeks to cater for individuals of all abilities, cultural and religious backgrounds, and any specific dietary or medical needs. Please use the space below to indicate any special needs you may have. This information will be retained by the RYLA Chairman and Co-directors and used only in case of emergency or to help manage a pre-existing requirement or medical condition. All information is treated with the strictest of confidence.
Do you require additional support to participate e.g. wheelchair access, etc? *
Do you have any allergies (e.g dairy allergy, nut allergy) or dietary requirements (e.g. halal, vegetarian)? *
Your answer
The RYLA conference includes some fun physical activity. Please let us know before the camp if you are carrying an injury or have a condition that may require assistance. *
Your answer
Medical contact details and medication information in the case of a medical emergency. All sensitive information will remain private. Do you agree to Rotary District 9820 RYLA program collecting & storing your data? *
Required
Name of Regular Doctor
Your answer
Doctor phone number
Your answer
Medicare Number *
Your answer
Private health insurance provider
Your answer
Ambulance Cover
Your answer
Emergency Contact #1: name & phone number *
Your answer
Emergency Contact #2: name & phone number *
Your answer
SECTION FOUR: RYLA RULES AND GUIDELINES
The RYLA team tries to make the program as much fun and as enjoyable as possible, while ensuring the comfort and safety of all participants. To help facilitate a safe and comfortable experience, we ask participants to adhere to the guidelines and rules outlined below.
Please read them carefully and tick each box to indicate you agree:
Participants are expected to adhere to meal and session times. *
Required
No alcohol or illicit drugs are to be used at, or taken to, Rawson Village and the RYLA Conference *
Required
Smoking is only permitted during breaks and in designated areas *
Required
Participants will be allocated gender segregated sleeping areas and will be expected to respect the privacy of others at all times. *
Required
Participants are to bring all personal items for the 6 day stay. Participants will not be permitted to leave the Rawson Village site during the course, there is no opportunity to visit shops, pharmacies, or supermarkets. *
Required
All participants are expected to pitch in with cleaning and general housekeeping. *
Required
Participants must abide by the rules of the Rawson Village Campsite and follow directions of Rawson Village staff and the RYLA Team at all times. *
Required
Mobile phone use will not be permitted during the day’s program (emergency phone numbers will be given to participants to pass on to family and friends in case of emergency). *
Required
Participants who engage in misconduct or disruptive behaviour during the program will have their participation in the program terminated and be asked to leave. *
Required
You will be financially sponsored to attend RYLA by a Rotary Club. As such, there is an expectation that you will participate in all sessions and activities in good faith. *
Required
SECTION FIVE: FINDING A SPONSOR
If your application is successful, a Rotary Club will sponsor you to attend RYLA. This means you pay nothing to attend. In return, you will be expected to attend a meeting of your sponsoring club after RYLA to convey your experiences.
Are you currently in contact with a Rotary Club that has indicated interest in sponsoring you? *
If YES please provide club details - Name of Club & contact's name
Your answer
If NO, your application will continue in the selection process. If successful we can seek sponsorship from your local club on your behalf.
SECTION SIX: INDEMNITY AND AUTHORITY
This section must be completed by the applicant.
To: Each and all members of Rotary District 9820 Rotary Youth Leadership Award Committee (“The Committee”) and each and all members of the Host Club.
INDEMNITY AND AUTHORITY:I hereby apply for the Rotary Youth Leadership Award (RYLA) and agree to abide by the Rules and Conditions of participation set out in this application form. In consideration of The Committee making a Rotary Youth Leadership Award to the abovementioned Awardee (“The Awardee”) and the Host Club including the Awardee in RYLA 9820 to be held as provided herein, I promise to indemnify and to keep indemnified each and all of you, your officers, servants and agents from and against all damages, claims, demands, costs and expenses of any nature whatsoever arising out of any accident or illness which may befall or occur to The Awardee during his or her participation in RYLA 9820. I further authorise you, your officers, servants and agents in the event of any accident or illness to obtain any medical assistance for The Awardee and I agree to pay all costs and/or expenses whatsoever incurred by you in respect of that assistance or treatment.Do you agree to the above Indemnity and Authority *
Required
Thank you for your interest in RYLA 9820, best regards the RYLA team
Your answer
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