RYLA Johor 2017 Application Form

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RYLA Johor 2017 Application Form RYLA JOHOR 2017 – “Leaders Making a Difference” 7th to 10th December, 2017 Tanjung Sutera Resort, Sedilli, Johor Organized by Rotary Club of Pasir Gudang, District 3310 RYLAs are designed for young adults with proven leadership ability and a commitment to community service. Whether you are a secondary school student, university student, or young professional, RYLA will help you discover your potential and develop the skills needed to be a leader in your community, career, and everyday life. A chance to be part of a worldwide Rylarian Community Develop your leadership skills and character Discover your hidden talents Develop self-confidence and public speaking skills Learn to work effectively in a team Gain exposure to a variety of issues and people Develop a sense of caring and understanding Meet active Community Leaders and Rotarians Learn valuable information and career skills All the while, you’ll also have fun, build friendships, and create memories that will last a lifetime. How to Enroll: Participants must be 14 to 24 years old and must be physically fit and need not be in Interact or Rotaract. All you need now is to fill up the attached registration form, send it to the respective Rotary clubs thru your school if you are Rotaractor or an Interactor and are eligible to be sponsored. If you are not and wish to participate on your own, send your registration form Section 1 and 2 (if applicable) with attached cheque , Bank Transfer or money order of RM 450.00 , issued to: “Rotary Club of Pasir Gudang” – CIMB 8006192368 Registration forms, cheque deposit slips or prove of bank transfer/ deposits should be emailed to: [email protected] Participants travelling from outside the state of Johor and Singapore must have travel insurance to cover any medical emergency and repatriation. Passport must have at least six months validity, failing which you may be denied entry into Malaysia. Visa applications are the responsibility of the participants from countries requiring entry visas into Malaysia. Getting to Tanjung Sutera Resort: Follow signs to “KOTA TINGGI”. In Kota Tinggi, follow signs to “MERSING”. Approximately 15 km from the Desaru-Kota Tinggi junction towards Mersing, look out for “TG SEDILI” signboard and turn right. Proceed for another 1 km and turn right towards “TG SEDILI” and drive for another 21.2 km till you see a 4-junction traffic light. You shall turn left into direction of “SEDILI BESAR” Cross over the bridge and drive on till you see “TANJUNG SUTERA” signboards. The resort is approximately 4 km from the Sungai Sedili Besar bridge. We will put up RYLA signs. OR fly to Senai Airport and join our RYLA Bus Dataran, Johor Bahru. Please check latest bus schedules and flight schedules. Air Asia provides an hourly free shuttle service from Senai Airport to JB Sentral Bus Terminal. Visit www.airasia.com and www.causewaylink.com.my for info. Visit www.tanjungsuteraresort.com for more information on the venue and directions Transport for participants will be provided from Dataran JB to camp site, please contact : Singapore–PP Chandran Pillay +659617-2121; Johor: Rtn Shendra +6017-756 1819 RYLA BUS will depart Dataran Clock Tower, JB at 10am sharp on 7 December 2017 What to Bring: Shorts, long trek pants for jungle trekking, swimwear for beach activities, t-shirts, warm jacket for chilly nights, 2 pairs of sport shoes, slippers, sunscreen, alarm clock, any medication that you are taking ( in labelled containers), party outfit for Celebration Dance night and an open and happy heart. What not to Bring: Valuables, Jewelry, expensive hand phones, computers and excessive money, alcohol, drugs and tobacco What we provide: 4 days 3 nights full board stay. 6 meals per day, plenty of water. Medical / First aid support. Accident Insurance Coverage 3 RYLA Tee-shirts, goody bag, stationery and course materials Transport to and from Dataran JB Clock Tower, Johor Bahru And unlimited fun and memories Any enquiries and transportation schedules please contact or write to the respective Rotarians: Singapore: PP Chandran Pillay +65 9617 2121 / +6012-993-1958 email: [email protected] Johor: PP Chew Kian Wee +6016-773 2736, Rtn Shendra +6017-756 1819 email: [email protected] Muar: PAG Senthil Doraisamy +6012-320-2912 email: [email protected] Kluang: PAG Simon Sim +6012-777 8733 email: [email protected] Note: RYLA begins at 12 noon Thursday 7th Dec and Ends at 2pm on Sunday 10th Dec Lunch will be provided on both days. RYLA FORM - SECTION 1 Registration Form Name Name on Tag (Be Creative IC/Passport Number Gender Date of Birth Email Address Home Address Home Phone Number Mobile Number Name of School/College/University/Employer Sponsoring Rotary/Interact Club/Organization/Rotarians Previous RYLAs Attended T-Shirts Size – XS/S/M/L/XL/XXL Dietary Requirement: Normal/Vegetarian/Allergies Medical Conditions Emergency Contact Person - Name/Mobile Phone/Relationship Transportation Own/Via RYLA Bus from Dataran JB Clock Tower Leaving Sedili on Signature of Participant __________________________ Registration Closing Date: 17th November, 2017 or until sold out Remark: 1. Limited to 120 pax only, full payment must be received prior to closing date. We apologize that we are unable to accept onsite payment due to resort no show penalty policy. We are also unable to accept late applications after the closing date due to logistics and insurance considerations 2. Organising committee prefer to accept participants with previous attended RYLAs of not more than 2 times 3. Organising committee welcome non Interactors/Rotaractors and working class adults to register as participants RYLA FORM - SECTION 2 PARENTAL/LEGAL GUARDIAN CONSENT FORM ( for applicants below the age of 18 ) I_________________________________________being parent or lawful Guardian of____________________________________, participant at The Rotary Youth Leadership Awards 2017 Johor, (RYLA JOHOR 2017) to be held from 7 to 10 December 2017at Tanjung Sedilli, Johor Bahru, hereby give consent to his/her participation at RYLA. I am fully aware that the Rotarians involved with the RYLA Program, the Organizing Rotary Club, namely Rotary Club of Pasir Gudang,trainers and facilitators (collectively referred to as the Organizers ) had put in place proper Risk Assessment Management Systems to safeguard the safety and welfare of all participants participant and fully accept that by this Consent and Release, his / her participation shall be at my sole risk and I hereby absolutely release and hold harmless and free from Liability, the Organizers from all claims, actions, suits in respect of any accident or damage and / or loss to property, personal bodily injury and / or death which may be suffered by the participant and I hereby undertake that I shall not file any actions, claims, demands, suits against the organizers arising there from. I also understand that the RYLA program has supervised outdoor activities that by my signing this consent hereby allow my child/ward to participate and hereby declare him/her to be physically fit for strenuous outdoor activities. My child/ward may refuse to participate in any outdoor activity by informing the organizer prior to the outdoor activity for medical or personal reasons. The Camp Commandant or his appointee reserves the right to terminate or postpone any published outdoor program due to inclement weather. I agree to allow the camp doctor or designated medical personnel to dispense any non-prescription medication to my child if necessary. In case of a medical emergency I understand every possible effort will be made to contact me, although in the event I cannot be reached I hereby give my permission to the healthcare provider selected by the Camp Commandant to hospitalize, secure proper treatment, order an injection, anesthesia, or surgery for my child whose name is listed above. I am also aware of Rotary policies with regards to Youth Travel (available from www.rotary.org ) and will therefore purchase necessary travel and medical insurance policies. ( for participants outside Johor and Singapore ) I also undertake to declare any existing medical conditions my child/ward has and declare any medications or allergies present. I am aware that the Organizers will only provide transportation to and from designated pick up/drop off points and the RYLA venue and I will be solely responsible his or her transportation to and from these locations and any post RYLA stay in Johor Bahru or Singapore. _____________________________________ Name and Signature of Parent/Legal Guardian .
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