Camp Sign Up

2017 Camp Dates: May 2nd to 4th
Deadline for application: March 8th

* A post dated cheque in the amount of $50.00 (Dated May 4th, made out to Rotary Camp Enterprise) must be submitted along with your application. This cheque is intended to secure commitment and prevent last minute drop outs from the camp. Upon attendance to the camp, the cheque will be returned uncashed to the student. If the student drops out of the camp with less then 30 days notice from the start date of the camp, without reasonable explanation (health or family emergency issues) the cheque will be cashed by the Rotary Camp Enterprise Committee to marginally offset the cost of that student.

Student Information

Full Name:
Home Address:
City:
Postal Code:
Home Phone:
Year of Birth:
Sex:
Grade:
Email Address:
School:
Sponsor Rotary Club:
Health Card #:
Do you have any allergies or special dietary requirements?
If yes, please specify:
Do you expect to be taking any prescription drugs during Camp Enterprise?
If yes, please specify:
Do you have any medical condition of which we should be aware?
If yes, please specify:
You are required to provide a resume / CV with your application:

Rules of Conduct:

To maximize the benefits of Camp Enterprise for all participants, we require adherence to the following
rules:

  1. Students are required to attend throughout the entire Camp Enterprise Program.
  2. No personal vehicles may be brought to the Camp.
  3. Visitations by non-participants are prohibited.
  4. The possession of alcohol or non-prescription drugs, or being under the influence of alcohol or nonprescription drugs, is not permitted.
  5. Participants will be assigned to a specific residence, and must not change their residence.
  6. No mixing of males and females in the residences is permitted at any time.
  7. Smoking is not permitted indoors.
  8. Each night a curfew time will be established, the purpose of which is to ensure you are rested for the
    next day's program. You are required to be in your assigned residence by curfew time.
  9. Chaperones will be on hand overnight to monitor residences and you are expected to obey their
    directions.
  10. Program segments may be video taped or photographed. Participants (and their guardians) give
    permission to Rotary to use these images for, but not limited to, promotion, advertising, news
    articles and website use.
  11. 30 days’ notice prior to camp commencement is required for withdrawing from the program. Health and family emergencies accepted.

Medical / General Consent Release:

If student is below the age of majority, the following consents and release must be signed by parent or guardian. If student is above age of majority, please provide emergency contact information.

  1. If the above named student becomes ill or suffers an accident while participating in Camp Enterprise, I hereby authorize the members of Golden Triangle Rotary Clubs to obtain reasonable and appropriate medical attention in the event that I cannot be reached to give this approval.
  2. I authorize the above student to attend Camp Enterprise and I hereby release the Golden Triangle Rotary Clubs and their members and the University of Waterloo and their staff and agents from any claims of any nature in connection with or arising from the student participation in Camp Enterprise.
  3. I have read the above Rules of Conduct for Camp Enterprise, and if I am selected to attend, I agree to follow the Rules of Conduct. I understand that if I violate the above Rules, I may be asked to leave the Camp.
  4. A postdated cheque in the amount of $50.00 (Dated May 4th, made out to Rotary Camp Enterprise) must be submitted at the time of your interview. This cheque is intended to secure commitment and prevent last minute drop outs from the camp. Upon attendance to the camp the cheque will be returned uncashed to the student. If the student drops out of the camp with less than 30 days’ notice from the start date of the camp, without reasonable explanation (health or family emergency reasons) the cheque will be cashed by the Rotary Camp Enterprise Committee to marginally offset the cost for that student.

Parent or Guardian Information

Name:
Day Time Phone:
Evening Phone:

Emergency Contact Information

Name:
Day Time Phone:
Evening Phone:

Medical / General Consent Release:

Camp Enterprise is run at the University of Waterloo, Ron Eydt Centre. Students are required to stay on
campus in student residence overnight May 2nd and May 3rd. All costs will be paid for by your
supporting Rotary Group. It is the student’s responsibility to be dropped off on May 2nd and picked up
May 4th at the agreed location. Transportation can be arranged by Rotary Volunteers if needed. Please contact your supporting Rotarian for further information or with questions.