2018 - Leadership Camp Application

2018 Applications are currently

ON HOLD

Your First Name *

Last Name *

All registrants MUST BE PRE-APPROVED by their school before applying.

School *

Grade in Sept 2018 *

*

	Exchange Student	Student	Jnr Chap	Snr Chap
I am applying as:	Exchange Student	Student	Jnr Chap	Snr Chap

Students are currently in a High School and must be preapproved by their school or their Interact club if applicable

Jr Chaps must have attended a previous Camp.

Snr Chaps are usually members of Rotary but may also be teachers or any adult.

Are you now or will you be a member of your school's Rotary Interact Club? *

	yes	no
Member of Interact ?	yes	no
On Club Executive ?	yes	no

Your Interact Club or School Advisor

Have you been involved in any other Rotary activities such as Camp Enterprise

or applied for Youth Exchange or .....?

*

Age in Sept 2018 *

Birthdate (YYYY/MM/DD) *

*

	male	female
gender	male	female

Sponsoring Rotary Club

Parents' Names

Home Address *

City *

Postal Code *

Telephone *

Email Address *

Family Doctor *

Dr Phone No *

School Leadership Avtivities *

Extracurricular Activities *

Hobbies *

Do you have a CGI certification? *

Assess your Swimming Experience and Expertise,(0 cannot swim - 5 Lifeguard certification) *

Assess your Canoeing Experience and Expertise, (0= never canoed, 5=expert) *

What do you want to achieve from the Camp? *

Any Special information such as Allegies, religious special needs or food conditions? *