THIS FORM IS TO BE READ AND KEPT BY THE STUDENT
Student Guidelines for Attending The Leadership Camp
The Leadership Camp is an exciting and challenging opportunity to learn some very valuable, skills and knowledge about Leadership. We want you to have a wonderful experience, so it is important that you be familiar with these guidelines. Please review them carefully.
Failure to comply with any of the first 3 rules will result in you being sent home immediately, at your expense. You will need to be picked up by your family or sent home by taxi.
1. No drugs or alcohol... PERIOD.
2. You are not permitted to visit the residence of the opposite sex.
3. You must stay on-site throughout the Camp event. You will be given the camp boundaries by the staff.
4. You will be given "to bed" and "lights out" times. We strongly discourage long chats or other activities during this time. You will be glad you had lots of sleep because the sessions are very busy and demanding of your attention and physical skills.
5. You and your family will be charged for any acts of vandalism.
8. No smoking anywhere.
7. No MP3 players, or other audio devices are permitted.
8. No food is permitted in any of the meeting rooms.
9. Please do not bring cell phones. Emergency and pay phones are available on site.
10. If you follow our guidelines and participate with all your energy, you will have FUN, you will learn priceless information and will have what will undoubtedly be one of the greatest experiences of your life.
The following form must be submitted before the student is allowed to attend the camp.
(revised 2012) Student Consent Form
Please save and printout a hard copy of this form and complete it.
This form, with a cheque for $75 made out to The Leadership Camp, is to be sent to Mr G.. Willard, 500 Kilarney Court, Burlington ON L7L 2N7
Absolute Rules:
1. There will be no alcohol or drugs allowed anywhere, anytime.
2. There will be no visitation at any time between the cabins of the oposite sex.
Failure to abide by these basic rules will result in being sent home immediately, by taxi at your expense or being picked up by your family.
I ______________________________________________(student's name- please print)
have read and understand, and will comply with all the rules for attending the Leadership Camp.
Signature: ___________________________ Date:_________________
All applications require Parent's Consent
Please have parent or guardian complete all of the following:
I, the undersigned parent/legal guardian of the above signed student, waive and forever discharge any and all damages on behalf of the above signed student, which may accrue against Rotary Clubs and/or the Pinecrest Camp and their respective officers, for any illness or injury which may be sustained and suffered during the above student’s participation in the Leadership Camp. I have read and understand part 2 (Student Guidelines for attending the Leadership Camp).
Parent/Guardian's Name:________________________________ (please print)
Signature of Parent/Guardian:_________________________ Date:________________
Contact phones: day phone:______________ night phone:___________________
cell phone:___________________
Privacy Policy:
I agree that the information provided in the application may be accessed by members of the Leadership Committee for purposes of organisation and communication. Yes No.
I agree that the communication information may be used to notify the student about other Rotary Youth activities and programs in the future. Yes No
Medical Consent
Name of Family doctor:____________________ Phone:__________________
OHIP # ___________________________
Medications:
Allergies:
Food restrictions:
In case of sudden illness or accident involving my child, I hereby authorize a Leadership adult Leader to take my child to the nearest public hospital for emergency treatment.
Signature of Parent/Guardian: ___________________________ Date:_______________