IMPORTANT: All medications must be in the original container. Medications will be administered by medical staff, and must be given to the staff member at registration. If your student must carry emergency medication (such as an inhaler), and may self-administer, please note under “Times Taken.”
blanks has my permission to participate in RYLA - Rotary Youth Leadership Awards on October 4, 2023 - October 8, 2023, at the Wendell H. Ford Training Center in Greenville, KY. I know of no health or fitness restrictions that preclude participation. In the event of illness or injury occurring to my son or daughter while involved in this activity, I consent to X-ray examination, anesthesia, medical or surgical diagnostic procedures or treatment that is considered necessary in the best judgement of the attending physician and performed by or under the supervision of a member of the medical staff of the hospital furnishing medical services. (It is understood that in the event of a serious illness or injury, reasonable efforts to reach me will be attempted.) Initial Required. blank In addition, since this is an overnight activity, students will be expected to go to bed and up at the times designated in the itinerary for the weekend. There will be absolutely no fraternizing between the boys and girls after lights out in the evening. This is considered a major behavior infraction and any major behavior infraction will result in the student being sent home early from RYLA. In case of any disciplinary issues, I will be notified. It is my responsibility to pick up my son/daughter from camp, immediately. Initials Required. blank I acknowledge that it is my responsibility (or the person designated on the application form) to pick up my child on Sunday, May 1, 2022 at the close of RYLA (approximately 3:00 pm CDT). I acknowledge that I have given a RYLA representative permission for my son/daughter to be picked up and driven to RYLA it for some reason, I am not able to drop off or pick them up. Legal Guardian Signature Signature Date Relationship to Student Phone number where I can be reached during the time of this activity.Home Mobile Work
Photo/Video Release: I hereby allow Rotary District 6710 to use photographs or images of my child for appropriate promotional materials.Parent Signature: Signature Date Print Name: