Delegate Application Information

Transcription

1 Delegate Application Information Welcome! Thank you for your interest in participating in the American Red Cross Leadership Development Camp as a delegate. A successful camp begins with a willing delegate who is committed to learning leadership skills, team building, and about service through volunteering. LDC is hosted by the American Red Cross Los Angeles Region. Junior and Senior LDC: There will be a junior camp for middle school delegates and a senior camp for high school delegates. Both camps will follow separate schedules during the day and will combine for nighttime activities and during mealtimes. Camp Site Information Pilgrim Pines Camp and Conference Center Glen Road Yucaipa, Emergency Calls ONLY: (909) (909) To Apply Junior Delegates must be entering grades 6-9 in the fall of Senior Delegates must be entering sophomore year of high school up to age 18. All Senior LDC Delegates must be Red Cross youth volunteers! Applications are due according to the fees schedule and must be received by July 12 NO EXCEPTIONS! Please plan accordingly if you intend to submit your application in person or via post. Mail Applications American Red Cross Los Angeles Region Attn: Leadership Development Camp Ohio Avenue Los Angeles, CA Scan/ Applications Jeanne Woo, CVE Associate Jeanne.Woo@redcross.org Application Deadline July 12, 2013 Delegate Fee Scale Early Bird Discount by May 15: $355 General Tuition by June 20: $395 Late Application by July 12: $445 For more information Please contact Jeanne Woo Community & Volunteer Engagement Associate (310) Jeanne.Woo@redcross.org **Please make checks payable to the American Red Cross and write LDC and the delegate name in the memo section. We are also providing a credit card authorization form for your convenience. Deposits are $100 with full payment by the timeline listed above in order to receive discounts. Deposits are non-refundable. All camp fees and deposits are nonrefundable after June 20, 2013.

2 CAMP DEPARTURE DAY: Space is limited, so delegates must register to ride the bus on their application. Bus transportation will be provided to the camp site on Monday, August 4, 2013 from the West Los Angeles Headquarters of the American Red Cross. Please arrive no later than 6:30 a.m. and sign in your child, noting the name/phone number of the person who is authorized to pick them up on the returning day. Breakfast is not provided so please eat before boarding. *Space is limited so please mark your application if you will be riding on the bus to camp. Full payment of camp fees MUST be submitted by June 20 th in order to ride the bus. Please note the difference for bus riders and other delegates!!!* CAMP RETURN DAY: The buses will be returning on Friday, August 9, 2013 to the West Los Angeles Headquarters of the American Red Cross. Our estimated time of arrival is 2:30 p.m. Photo IDs will be checked during sign out. DELEGATE ORIENTATION DATES: LDC staff will be hosting several Delegate Orientations from June through July at their local Chapters. These orientations will introduce delegates to LDC and go over what to expect from camp. Registered delegates will receive an Orientation Schedule via after June 20, If you would like to attend an orientation but did not receive any information about dates after June 20 th, please contact Jeanne Woo, Community & Volunteer Engagement Associate by phone at (310) or by at WHAT IS LDC? About Leadership Development Camp The American Red Cross is committed to training and empowering youth in our community. Over five days, junior high school and high school students build confidence and cultivate core leadership skills such as teamwork, public speaking, and diversity/cultural understanding. These are skills which can later be used on school campuses and in life. As American Red Cross youth volunteers, staff members create sessions and activities that reinforce delegates individual and team leadership skills. Over 100 youth came back each year as stronger individuals. They form friendships that often last a lifetime. Moreover, they become leaders who make a difference in their schools and communities. WHAT MAKES LDC UNIQUE? LDC is completely planned and staffed by high school and college youth. What is most unique about LDC is that leadership lessons don t end on the last day of camp they continue for the youth who come back to staff the camp, and for those around them. Youth learn fundraising, marketing, and time management/planning skills. LDC is leadership by youth, for youth. We focus on core leadership skills first in an active environment. There are no lectures! Sessions and activities are about doing, and that s a standard at LDC. WHAT CAN I EXPECT TO GET OUT OF ATTENDING LDC? Expect to expand your world by sharing your experiences with youth from all over Southern California. Be prepared to open your mind and learn something new about yourself and about what s going on in the world. Discover what you can do to make a positive impact in your life and in your community.

3 Delegate Application Application Deadline July 12, 2013 Incomplete applications will not be accepted and deposit will not be refunded. Please be sure to complete the entire application before submitting it. Delegate Fee Early Bird Discount $355 ($100 deposit and $255 remaining by May 15); General Tuition $395 ($100 deposit and $295 remaining by June 20); Late Application $445 ($100 deposit and $345 remaining by July 12). Deposits are nonrefundable. All applications and fees must be received by July 12, 2013 No exceptions! Delegate Information First Name Last Name Preferred Name Gender Address City/Zip Date of Birth Address Home Phone Cell Phone School attending in the Fall Grade in the Fall Ethnicity Age Red Cross Chapter Affiliation Food Preferences (and/or allergies) T-Shirt/Sweatshirt Size Have you attended LDC? (List years) What camp will you be attending (Junior or Senior)? Will you need to ride on the bus? (Limited Space available!) Yes No School and Extra Curricular Activities Please list any school and extra-curricular activities you are involved with this year Name of Activities Description and Time Commitment Level

4 Red Cross Training and Service Projects Please list any Red Cross Training you have received and list Red Cross Service Projects you participated in Training Service Projects Questions for ALL Staff Please answer the following questions in the space provided. 1: What motivated you to apply as a delegate for Leadership Development Camp 2013? 2: What are your expectations of LDC 2013 and what do you hope to gain from your experience at camp?

5 3: Describe a time in your life where you took a lead on something OR a time when you made a difference? Please list any last thoughts or qualifications that you would like us to know when considering accepting you as an LDC 2013 delegate. Signatures I have read, understand and received a copy of the Delegate application and Leadership Development Camp rules for the 2013 LDC. I have reviewed the application deadlines and other required dates and there are no known conflicts with any listed. I fully understand that inability to fulfill these commitments could result in being released as a Delegate. To the best of my knowledge all statements in this form are true, and any misrepresentation will call for immediate dismissal. I acknowledge the above information is voluntarily supplied and may be used and disclosed for Red Cross purposes only. Finally, I agree to abide by the policies and procedures of the American Red Cross. Applicant Signature Print Name Date Applicants under 18 must have parent s signature As the parent of I have carefully reviewed the requirements and commitments necessary for my son or daughter to serve as a Delegate for LDC I fully support my son or daughters desire to participate and give my permission to do so. I understand that if my son or daughter cannot fulfill the commitment to attend camp in its entirety and behave according to the expectations for delegates, this may be cause for their dismissal from LDC 2013 and will result in forfeiture of any camp fees. Parent Signature Print Name Date

6 AMERICAN RED CROSS LIABILITY WAIVER (For events involving adult and minor participants) I/my minor child, wish/es to participate in the Leadership Development Camp orientations at local Red Cross Chapters and summer camp to be held at Pilgrim Pines in Yucaipa, CA August 4-9, I am aware that participation in the Activity is potentially hazardous and entails a risk of physical injury. I understand and agree that I/my child am/is electing to participate at my/his/her own risk. I am not aware of any physical or medical condition that would interfere with my/my child s ability to participate. IN CONSIDERATION OF MY/MY CHILD BEING PERMITTED TO PARTICIPATE IN THE ACTIVITY, I HEREBY RELEASE AND DISCHARGE THE AMERICAN NATIONAL RED CROSS, AMERICAN RED CROSS GREATER LONG BEACH CHAPTER, AND GREATER LOS ANGELES CHAPTER AND ALL OF THEIR EMPLOYEES, VOLUNTEERS, OFFICERS, AND AGENTS ( RELEASEES ) FROM ANY AND ALL CLAIMS FOR PERSONAL INJURY, DEATH, OR PROPERTY DAMAGE ARISING FROM OR IN ANY WAY CONNECTED WITH MY/MY CHILD S PARTICIPATION IN THE ACTIVITY, EXCEPT WHERE THE SAME IS CAUSED BY THE WILLFUL MISCONDUCT OR GROSS NEGLIGENCE OF THE RELEASEES. For parents/guardians of minor participants only: As the minor s parent/guardian, I hereby consent to his/her participation in the Activity. If my child is injured or becomes ill and neither I nor the other parent/guardian can be reached at the numbers below, I give the American Red Cross permission to seek medical attention for my child. BY SIGNING THIS WAIVER, I AFFIRM THAT I HAVE READ AND UNDERSTAND IT AND AGREE WITH ITS CONTENTS. Signature of Participant (over 18) or, if Participant is a minor, the Participant s Parent/Guardian Date Printed Name of Participant (over 18) or Participant s Parent/Guardian Photo Release I understand that I/my child may be photographed during the course of the Activity. I grant full and unlimited permission to the American Red Cross, and their agents and affiliates to use my/my child s name, photographs or any other record of participation in this Activity in any broadcast, telecast or other account of the Activity for publicity purposes, without compensation, by placing my initials here. Parent/Guardian/Emergency Contact 1: Name: Relationship: Daytime: Evening: Cell: Physician Name: Parent/Guardian/Emergency Contact 2: Emergency Contact Information (To be provided by parent/guardian of minor participant) Name: Relationship: Daytime: Evening: Cell: Physician Phone:

7 August 4-August 9, 2013

8 Credit Card Payment Form Delegate and Payment Information Delegate First Name Delegate Last Name Date Name on Card Credit Card # Exp. Date Security Code Billing Address City/Zip Phone Number Card Holder Signature Date Notes Please charge my credit card: $100 Non-Refundable Deposit only $100 Non-Refundable Deposit now and balance by, 2013 $ Delegate Fee Paid in Full now I would like to make a Tax-Deductable Donation to the LDC Scholarship Fund to help fund delegates and staff in need of financial assistance. $ $25 $50 $100 $210 $ I would like to give Assist with partial scholarships Staff scholarship Delegate scholarship Please complete and return with your application to: American Red Cross Los Angeles Region Attn: Leadership Development Camp Ohio Avenue Los Angeles, CA Delegate Fees All perspective delegates must turn in their $100 non-refundable deposit with their application (will be returned if not selected) and submit remaining balance according to fees schedule and no later than July 12, **Please make checks payable to American Red Cross and write LDC & staff name in the memo section on all checks. We have also provided a Credit Card Authorization form, for your convenience. Deposits are non-refundable unless the applicant is not accepted as a delegate. Delegates failing to meet the orientation and behavior expectations will not receive a refund on any camp fees. All camp fees and deposits are non-refundable after July 12, 2013.