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Camp RYLA | Rotary Districts 5950/5960
Rotary Youth Leadership Awards
Camp RYLA | Rotary Districts 5950/5960Camp RYLA | Rotary Districts 5950/5960
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    • Photo Submission
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Student Application

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Student Information

Name(Required)
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Address(Required)

Parent/Guardian Information

Name(Required)
May we send texts to this number, if needed?(Required)

Rotary Club Sponsoring Information

Please supply this if you do not know what club is sponsoring you
Your Rotary Contact's Name
If known
If known
All medical and medication information will be kept confidential.
For instance, the cabins and restrooms at Camp St Croix built to be divided by gender; there is no formal dedicated time in the schedule for religious observances; and some areas of the property are harder to navigate for all abilities.
Would you like to discuss any of the above with a member of camp staff prior to the camp including discussions of housing, meals or other matters where you might want/need special accommodations?
CAMP RYLA MEDIA/PHOTO RELEASE FORM(Required)

I hereby grant Camp RYLA, Rotary District 5950, and Rotary District 5960 permission to use my likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration.

I understand and agree that all photos will become the property of Camp RYLA, Rotary District 5950, and Rotary District 5960 and will not be returned.

I hereby irrevocably authorize Camp RYLA, Rotary District 5950, and Rotary District 5960 to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo.

I hereby hold harmless, release, and forever discharge Camp RYLA, Rotary District 5950, and Rotary District 5960 from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I HAVE READ AND UNDERSTAND THE ABOVE PHOTO RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENTS/GUARDIANS AS EVIDENCED BY THEIR SIGNATURES ON THE PARENT FORM.

RELEASE, INDEMNIFICATION AND HOLD HARMLESS AGREEMENT
In consideration of participating in Camp RYLA activities, and for good and valuable consideration, I hereby agree to release and discharge any liability which may arise from such participation (1) the YMCA Greater Twin Cities; and (2) the Rotary Clubs of Rotary Districts 5960 and 5950, along with the owners, directors, officers, employees, agents, members, volunteers, participants and all other persons or entities acting for or on behalf of either organization (hereinafter collectively referred to as “Releasees”), on behalf of myself, my parents, siblings, heirs, assigns, personal representative and estate, and also agree as follows:
  1. I acknowledge that participating in RYLA/YMCA activities involves known and unanticipated risks which could result in physical or emotional injury, paralysis or permanent disability, death, and property damage. Risks include, but are not limited to, broken bones, torn ligaments or other injuries as a result of falls or contact with other participants; death as a result of drowning or brain damage caused by near drowning in pools or other bodies of water, medical conditions resulting from physical activity, and damaged clothing or other property. I understand such risks simply cannot be eliminated, despite the use of safety equipment, without jeopardizing the essential qualities of the activity.
  2. I expressly accept and assume all of the risks inherent in this activity or that might have been caused by the actions of the Releasees. My participation in these activities is purely voluntary and we elect to participate despite the risks. In addition, if at any time I believe that event conditions are unsafe or that I am unable to participate due to physical or medical conditions, then I will immediately discontinue participation.
  3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Releasees from any and all claims, demands, or causes of action which are in any way connected with my participation in these activities, or my use of their equipment or facilities. This release does not apply to claims arising from negligence or intentional conduct. Should Releasees or anyone acting on their behalf be required to incur attorney’s fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.
  4. I represent that I or my family have adequate insurance to cover any injury or damage I may suffer or cause while participating in this activity, or else I agree to bear the costs of such injury or damage myself. I further represent that I have no medical or physical conditions which could interfere with my safety in these activities, or else I am willing to assume – and bear the costs – all; risks that may be created, directly or indirectly, by any such condition.
  5. In the event that I file a lawsuit, I agree to do so in the state where such injury incurred, and I further agree that the substantive law of that state shall apply.
  6. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect.
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RYLA Non-Discrimination Policy

RYLA is committed to providing all students with a safe and supportive environment free from discrimination on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, or sexual orientation in any of its activities or operations. For more information on Rotary International’s gender inclusion policy, please visit the LBGT Fellowship.

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