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RYLA Application 2011_draft1

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                                               RYLA 2011
                                           Rotary Youth
                                        Leadership Awards
                                            Weekend




                                          March 4, 5, 6, 2011
                                     Hosted by Rotary District 5260
                                        Salvation Army Camp Crag,
                                               Calabasas, CA



What is RYLA?
The Rotary Youth Leadership Awards (RYLA) is an intensive weekend of workshops, exercises and
camaraderie where young adults learn and practice the leadership skills necessary to excel in today’s
quickly changing world. The program’s goals are to:
           Help students become aware of how their actions affect others
           Provide the tools to inspire, focus and lead a group of peers
           Provide roll models for the students to emulate
           Develop the skills and character required by leaders
           Inspire the participants to continue developing their leadership abilities
           Practice and develop their individual communications skills

District 5260 RYLA Event
For over 20 years, Rotary District 5260, which includes the Glendale, Burbank, San Fernando Valley,
Santa Clarita, Antelope Valley, Bishop and Mammoth Lakes areas, has run its very successful RYLA
Event at the Salvation Army Camp (Crag) at Malibu Creek State Park in Calabasas, CA. Lead by
Rotarians and other community leaders, the weekend focuses on building friendships, self-awareness,
and leadership skills. Throughout the weekend, the participants gain, and apply their new skills and
knowledge to solve real-world problems that are presented to them throughout the workshop.

Selection, Activities and Fees
The District 5260 RYLA is designed for high school students in their sophomore and junior years.
Students are selected by their school sponsors in coordination with their community Rotary Clubs.
Each school is asked to select interested students who are active campus leaders or have demonstrated
leadership capabilities. Students are expected to have a grade average of “C” or better.

An application fee of $30.00 is paid by the student. The fee is refunded if the student is not selected to
attend the RYLA workshop. Rotary District 5260 pays the remaining cost (over $300 per participant). If
the application fee creates a hardship, please include a letter explaining the individual’s situation.
Applications received by Friday, February 11, 2011 will be given priority. Applications received after
that date will be processed on a first come first served basis.
Having successfully completed the workshops and making many new friends, students are encouraged
by Rotary to continue to meet and share their experiences and help those who did not attend by
becoming active in, or forming a Rotary “Interact” Club at their school. See the District’s website at
www.Rotary5260.org/RYLA for more information about the RYLA weekend including YouTube video
links. For information on how to start an Interact Club at your school, go to www.rotary.org or contact
Victoria Burke (818) 675-8327 or by email at ryla5260@gmail.com.

What former participants say about their RYLA experience:
   “It was a great opportunity for us to meet leaders from other schools and discuss our experiences
        and learn from each other.”
   “I learned a lot of leadership skills and also met a lot of people and made new friends.”
   “Every single thing we did was fun… and I learned a lot of leadership skills.”
   “It changed my life!”

Transportation
Buses will be provided from convenient pick-up points. Information on assigned pick-up point will be
included in the letter of acceptance. All students must arrive by the provided transportation.

What to Bring?
Students will be assigned to heated dorms during their stay at the camp and should bring:
 Sleeping Bag & Pillow        2 Days change of comfortable and warm    Camera
 Toothbrush                   clothing (you’ll be outside at night)    Flashlight
 Toiletries (shampoo, etc.)   Sneakers (that can get muddy)            Alarm clock
 Towel                        Rain gear (in case of rain)              Guitar or Musical
                                                                       Instruments
Electronic devices cannot be used during workshop sessions

The Object of Rotary
The object of Rotary is to encourage and foster the ideal of service above self as the basis of worthy
enterprise and, in particular, to encourage and foster:
First:  The development and acquaintance and an opportunity for service.
Second: High ethical standards in business and professions, the recognition of the worthiness of all
        useful occupations, and the dignifying of each Rotarian of his or her occupation as an
        opportunity to serve society.
Third: The application of the ideal of service by every Rotarian to his or her personal, business and
        community life.
Fourth: The advancement of international understanding, goodwill and peace throughout a world
        fellowship of business and professional people united in the ideal of service.

The Four Way Test of The Things We Think, Say, or Do
From the earliest days of the organization, Rotarians were concerned with promoting high ethical
standards in their professional lives. One of the world's most widely printed and quoted statements of
business ethics is The 4-Way Test, which was created in 1932 by Rotarian Herbert J. Taylor.
       1.   Is it the Truth?
       2.   Is it Fair to All Concerned?
       3.   Will it Build Goodwill and Better Friendships?
       4.   Will it be Beneficial to All Concerned?
         Rotary International District 5260 — RYLA Application                                             Office Use Only:
                                                                                                            Waiver
                                         March 4,5,6, 2011                                                  Fee
                                                                                                            Hardship


Instructions:
Please complete the application (2 pages) and waiver (1 page). Preference is given to applications
received on or before Friday February 11, 2011. The application fee of $30.00 will not be cashed if you
are not selected. Applications received after 2/11/11 will be processed on a first come first serve basis.

Note: Please mail the application, waiver and check (made out to Rotary District 5260) to:
                  Matt Schaaf, 17717 Tulsa Street, Granada Hills, CA 91344
                               (818) 269-8045—mattschaaf@aol.com
        For more information, visit our website at: www.rotary5260.org or call:
               Victoria Burke (818) 675-8327 email: ryla5260@gmail.com
            Gus Camacho (661) 609-9926 email: gus@camachoauto.com

Student Name: ________________________________________________________________________
Address: _____________________________ City: __________________ Zip: ____________________
Phone No.: (____) ____________________ Email: __________________________________________
School: _______________________________City:____________________________________________
School Administrative Contact: ______________________________ Phone: (____) _______________
Sponsoring Rotary Club: ________________________________________________________________
Rotary Contact: _____________________________ Phone: (____) ______________________________
Note: If the application fee is a hardship, please include a letter explaining your situation. All letters are strictly
confidential.     Fee Enclosed: Yes _____ No _____                Hardship: Yes _____ No _____

Sex: Male      Female                  Age: ______                Class: Freshman Sophomore Junior Senior
Interact Member: Yes No                                           Have you attended RYLA before? Yes               No

Please tell us about yourself. Be sure to include any awards, foreign languages, AP classes or additional
education, sports played, instruments played, hobbies, interests, etc.
Education:
___________________________________________________________________________________________
___________________________________________________________________________________________
Career Goals/Aspirations:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Hobbies and Interests:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Job/Employment and Community Volunteer History:
__________________________________________________________________________________________
__________________________________________________________________________________________

Organizations in which you participate: (please indicate any offices that you held)
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

What makes you a good candidate for RYLA?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

What leaders have inspired or influenced you?
What qualities do they have that you admire?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
What do you consider to be a moral obligation?
Describe something you do in your life that you consider to be a moral obligation.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

RYLA Challenge: Describe a local community problem that you would like to solve. How would you do it?
What resources will it require? Who will benefit as a result?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

Do you require vegetarian meals?           Yes   No
                        Waiver of Claims and Medical Authorization
                                Parent Consent for RYLA 2011 Conference

To Rotary District 5260:
I am aware and agree that the Salvation Army’s Camp Crag will be the site for this conference that will run
from March 4, 2011 through March 6, 2011. It will be under the supervision of District 5260 or Rotary
International.

I give permission to my son/daughter/ward to attend the RYLA 2011 conference and understand that
transportation to and from Camp Crag will be furnished by District 5260 or Rotary International.

I agree to direct my child to cooperate and confirm with directions and instructions of the person(s) in
charge.

Should it be necessary for my child to have medical treatment while participating in this trip, I hereby give
Rotary District 5260 personnel permission to render the medical treatment deemed necessary and
appropriate. I understand that Rotary District 5260 has no insurance that will cover any medical and
hospital costs that may be incurred for the benefit of my child and, therefore, any such costs incurred for any
treatment shall be my sole responsibility.

I also agree to hold harmless and waive any and all claims against Rotary International, Rotary District 5260,
and its members, those appointed by Rotary District 5260 and any person employed by The Salvation Army
and Camp Crag, for any injury, accident, illness or death occurring during or by reason of this trip.

I HAVE READ AND UNDERSTAND THE FOREGOING STATEMENTS AND AGREE TO ASSUME THE RESPONSIBILITY
STATED AND WAIVE ALL CLAIMS AS INDICATED.


Please Print Clearly
Student Name: _______________________ Parent/Guardian Name: ______________________________
Parent/Guardian Signature:__________________________________________________________________
Parents Phone: (____) __________ Work Phone: (____) ____________ Cell Phone: (____) _____________
Emergency Contact Name: __________________________ Emergency Phone: (____) _________________
Insurance Company: ________________________ Policy No.: _____________________________________
Doctor’s Name: _________________________________ Phone Number: (____) ______________________
Does your child have any allergies? Yes No To: ______________________________________________
Does he/she get severe reactions? Yes No Please explain: _______________________________________
__________________________________________________________________________________________
Is your child currently taking any medications? Yes No If yes, what are they? _____________________
___________________________________________________________________________________________
Will they have the medications with them? Yes No
Does your child have any special medical considerations? Please explain:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

				
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