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Apply to attend RYLA Elevate

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This application to attend RYLA Elevate should take you about 10 minutes to complete.

Have the following information available to complete the EOI:

  • Your personal information including contact details and date of birth
  • What you are currently doing for work, study or fun
  • If a Rotary Club is financially supporting your attendance, their contact details
  • Key medical / dietary information

The information is collected to assist with the RYLA Elevate application process and management of the retreat. Further details about how we use your personal information is provided at the end of this form.

Date of birth*
This email will be used for confirmation and communication.
Phone*
We may contact you by phone or text to confirm your availability and send updates about the retreat.

Pronouns*
For more information about pronouns and why we are asking, see: Minus18

Gender*

Do you identify as cis or trans?*
Cis includes persons whose gender is the same as their sex recorded at birth.
Are you of Aboriginal and/or Torres Strait Islander origin?
For persons of both Aboriginal and Torres Strait Islander origin, mark both responses: Yes Aboriginal, and Yes Torres Strait Islander.

Have you attended a RYLA program before?*
Please enter a number from 9000 to 9999.

About you

Please be as detailed as possible in this section as your responses will be sent to a Rotary Club to assist them when considering your application. If your answers are not detailed enough we may come back to you to ask for more.

Around 100 words
Are you currently in contact with a Rotary Club that has indicated interest in financially sponsoring you?*
Your RYLA Elevate fee can either be paid by you or a sponsor Rotary Club. If you answer ‘yes’ here your full attendance fee will be invoiced to your Rotary contact. If you answer ‘no’ you will need to pay the attendance fee using a credit card before submitting this form.

Sponsor Club

Your form will be automatically sent to the sponsor club so please ensure that you enter these details carefully, especially the email address. If you don’t have this information please save the form, confirm the info and come back. Your sponsorship cannot be processed without this information!

Just enter the club’s name, not the “Rotary Club of” bit. For example, “Rotary Club of Anytown” is just “Anytown”.
Are you interested in presenting at a TEDx style event?*
One of the highlights of Elevate is our TEDx-style evening, where participants have the opportunity to share their own TEDx-style talk on any topic of their choosing. It’s a great opportunity to share a story about anything you’re passionate about and build confidence speaking in a safe environment.
Transport*
How do you plan on arriving and departing RYLA Elevate. It’s ok if this changes but please let us know if it does.

This includes sheets for your bed (blankets are already provided) and a towel for an extra $25. If you would be more comfortable with a sleeping bag and will bring your own towel, select ‘no’.

Supporting your attendance

We require this information to support you in case of an emergency, and to ensure we meet individual needs at the RYLA Elevate retreat. Responses to the questions in this section are optional, but if you do not respond we may not be able to meet your individual needs.
Do you have, or are you aware, of any medical or medical-related condition which may impact the safety of yourself or those around you that we need to be aware of? This includes use of any scheduled medications.
Are there any requirements that we would need to consider for you to be able to fully participate in the program? This includes any mental health, learning, access or other needs. We will do our best to meet these needs or contact you if we need to discuss further.
Have you been diagnosed at risk of anaphylaxis?*
Please upload a copy of your anaphylaxis action plan. If you don’t have it, please save the form, get a copy and come back to complete it.
Max. file size: 2 GB.
If this is an allergy which requires medicine or is triggered by environmental hazards please write a detailed description of how you and others manage this.
Are you a snorer or a light sleeper? We will do our best to group the snorers and the light sleepers together. Anything we need to know about dorm room arrangements, especially for trans, gender diverse and non-binary participants? Note that you will be sharing a room at RYLA Elevate with between 2 and 4 people.
We will do our best to cater to your needs but cannot make guarantees unless there is a medical/religious reason behind your request. This includes halal, vego, vegan, fussy eating and anything else. If you don’t tell us now we CANNOT cater for your needs!!
Emergency contact number*

Consent

Please read and agree to the following rules and conditions. Please note that many of the rules and conditions are for health and safety reasons.

RYLA Elevate retreat terms*
I agree to:
• Participate fully in the retreat
• Abide by the guidelines set by the RYLA Elevate team
• Not take or consume alcohol and/or illicit drugs during the conference
• Not leave the RYLA location without notice to/authority from the RYLA Elevate team

I understand that:
• The RYLA Elevate team strives to create a positive experience for all events and unacceptable behaviour such as bullying, abusive language, negative attitudes will not be tolerated.
• I may be evicted from the retreat due to misconduct and/or insolence at the discretion of RYLA Elevate team and no refund will be provided.
• Registration fees are non-refundable, except where a refund is required under Australian Consumer Law.
Release and Indemnity*
I, the above named applicant of the above address am aware and acknowledge that participating in Rotary Youth Leadership Award (RYLA) Elevate retreat involves inherent risks, including the risk of injury to life or death and damage to property and in undertaking such activities, I do so at my own risk.

I am also aware that it is a condition of participation at RYLA Elevate that Rotary International (Rotary), including Rotary Oceania RYLA Alumni Association Inc., their officers and employees, agents and volunteers are released by me from all liability howsoever arising from injury or damage to both property and person howsoever caused (whether fatal or otherwise) arising out of my participation at RYLA Elevate whether or not such injury or damage is due to any negligent act, breach of duty, default and/or omission on the part of Rotary, their officers and employees, agents or volunteers.

I indemnify Rotary, their officers and employees, agents and volunteers against all loss, damage and expenses (including legal costs on a solicitor and own client basis) arising out of or in connection with any claims, actions, proceedings or demands of any kind arising directly or indirectly as a consequence of my participation at RYLA Elevate.

In the case of an emergency I authorise Rotary, where I am unable to be consent, to arrange for me to receive medical or surgical treatment as deemed necessary. I also consent to undertake any payments or reimburse costs which may be incurred for medical attention, ambulance transport and medication while I am in Rotary’s care.

I acknowledge and agree that my participation at RYLA Elevate is as a consequence of my own free will and desire and that I have read and understood the above warning, release and indemnity.

I warrant that I am 18 years of age or older and am lawfully able to enter into this above release and indemnity.
Privacy statement*
Rotary Oceania RYLA Alumni Association Inc. will collect and store the information you voluntarily provide. The information will be stored in a manner so that it will only be accessed by authorised Rotary Volunteers, and subject to privacy restrictions. The information is collected to assist with the RYLA Elevate application process and management of the retreat. Some of this information will also be provided to Rotary Clubs to provide sponsorship for your place at the conference and to medical professionals where necessary.

Rotary is committed to protecting the privacy and confidentiality of your personal information. Our privacy policies adhere to the National Privacy Principles, as required under the Privacy Act 1988. A copy of our privacy policy is available online at https://my.rotary.org/en/privacy-policy?embed=true.

We use Microsoft 365 to collect and store your information; for information about the security of Microsoft 365 see: Privacy at Microsoft.
Media consent
Rotary International (Rotary), including the Rotary Oceania RYLA Alumni Association Inc., would like your consent to take photos and/or video you at the RYLA Elevate Retreat.

During the event you may be photographed or videoed in activities such as:
• attending this program or event
• talking about the program listed above

Consent is when you agree to something.

You are giving us consent to use these photos or video:
• on our websites and social media
• in information or advertising about Rotary International
• in newsletters or other communications to the public

Your privacy
Photographs and film of a person that may be capable of identifying the person may constitute a collection of ‘personal information’ under Australian privacy law. Rotary values the privacy of every person and must comply with Australian privacy law when collecting and managing all personal information.

Ownership and Reproduction
Copyright in the images will be wholly owned by Rotary. This means that Rotary may use the images in the ways described in this form without notifying, acknowledging or compensating you.

What you are agreeing to
• you have read this information
• you give us consent to take photos or video of you
• you understand that we may use the photos or video of you in the ways we list above
• your consent starts from the date you submit this form.

Withdrawing your consent
If you want us to stop using the photos or video of you, you must tell us by emailing info@rylaoceania.org.

We will not use them again, but we may not be able to remove them from things that have already been published.
Please sign here that you have read and accept the RYLA Elevate Retreat Terms, Release and Indemnity, Privacy Statement, and Media Consent.
Clear Signature

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