REQUIRED BY ST. LAWRENCE COLLEGE & DISTRICT 7040
FOR UNDERGRADUATE RYLA
The RYLA Program involves a variety of activities that often include games, group initiative problems, low and high ropes course elements, other physical adventure activities, and living in a residence hall. Attendance at all events is required while the level of participation in an individual activity is at all times completely up to the individual's choice. Yet there is a risk, which must be assumed by each participant that he or she may suffer an emotional or physical injury.
Policy for participation in this program requires that every participant complete this form and the candidate information form. Certain health medical information must be made known to the leaders conducting your course so they are prepared to respond appropriately if the need arises. This information will be held in confidence. Please complete this form and return it along with the candidate information from to your sponsoring Rotary Club. This completed form is necessary to participate in the District 7040 RYLA program at St. Lawrence College, June 8 - 10, 2018.
We the parents/guardians and I, the applicant, are aware that the activities in which I plan to participate involve certain personal risks. I have noted on the "delegate application form" any medical or physical conditions I have which might effect my participation in this activity. I therefore, release all right of claim for damages against Paul Smith’s College, Rotary International, Rotary District 7040 and Rotary District 7040Clubs, and all individuals assisting with and conducting these activities for any injuries suffered by me in connection with this activity. In the case of an emergency, I give the leaders of this activity permission to authorize emergency medical treatment by a licensed physician, surgeon, dentist for me, to select the appropriate medical facility and physicians/dentists to provide that treatment.
We/I give permission for any operation, administration of anesthetic or blood transfusion, which a medical practitioner may deem necessary or advisable for the treatment of our son/daughter. We do request that we be notified as soon as possible. Use this phone number...