HOW DO I APPLY | Rotary District 5340

Students – HOW DO I APPLY?

LEAD Conference Dates October 12 & 13, 2024

If you are an 8th grade student and have been selected to participate in LEAD you must follow the steps below to complete the application process.

1. Please read all instructions and review the Student Application below before beginning.

2. You must be able to attend both days of the LEAD conference (see dates above and check your personal and family calendars).

3. Make sure that your parents are present and that you are working on a computer with a connection to the Internet.

4. Fill in all the information in the “About You” section.

5. A parent or guardian must fill in all the information in the “To Be Completedf by Parent/Guardian” section and the “In Case of Emergency, Please Contact” section.

6. A parent or guardian must add their signature (simply place the cursor in the box provided and hold down the select button to use the mouse to sign) and add the date.

7. Click on “Submit.”

8. If required information is missing, please add it and click on “Submit.”

9. A LEAD representative will contact you with additional information about LEAD including the bus transportation schedule, camp rules, emergency contact phone numbers, etc.

10. Additional information is available on this LEAD website.

11. NOTICE: Due to Covid, the San Diego County Office of Education requires every Student who will attend LEAD at Cuyamaca Outdoor School to be free of any symptoms of illness. If symptoms develop while at LEAD, a parent or guardian must be available during both days of LEAD to pick up their student and take them home.

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HOW ARE DELEGATES SELECTED FOR LEAD?

Students must be in the 8th grade at the time of the camp and must reside within San Diego County, Imperial County, or Blythe, California. Students are selected by their schools to participate based upon past leadership experience, future potential for leadership, ability to collaborate with others, service activities, good study habits, and a committment to academic success.

WHERE IS THE LEAD CONFERENCE HELD?

LEAD will take place at San Diego County Office of Education’s Camp Cuyamaca in San Diego County.

IS THERE A COST TO ATTEND THE LEAD CONFERENCE?

There is no cost to the student, to the student’s family, or to the school. All student costs and expenses will be fully paid by the Rotary Clubs of District 5340.

HOW DO I GET TO THE LEAD CONFERENCE?

Unless you receive information to the contrary, all students will be transported to and from LEAD on professionally driven, commercial buses with current state, federal, and CHP required certifications. Each student must travel to and from LEAD on their assigned bus. The LEAD Registrar will contact each student by email with information about which bus the Delegate is to ride to and from LEAD.

2024 Student Application

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ABOUT YOU

Your Name(Required)

First Last

My Friends Call Me

Birth Date(Required)

Sex(Required)

Your Address(Required)

Street Address City ZIP Code

Students Cell Phone(Required)

Home Phone

Parents Cell Phone(Required)

Parents Work Phone

Students Email(Required)

Parents Email(Required)

School(Required)

Adult Shirt Size(Required)

I am in the 8th grade(Required)

TO BE COMPLETED BY PARENT/GUARDIAN

MEDICAL HISTORY OF APPLICANT: (All medical information must be disclosed for the Delegate's safety and is kept strictly confidential by our professional medical staff members). 

Vegetarian(Required)

Dietary restrictions

Does applicant have any physical limitation or other condition or illness that is being treated that may require assistance while at camp?(Required)

If YES, describe

Is applicant currently taking medication?(Required)

If YES, please list what medications are being taken

If YES, please explain condition medication is being used/prescribed for

Physician/Doctor name(Required)

Phone

Health Insurance Carrier(Required)

Phone

IN CASE OF EMERGENCY, PLEASE CONTACT

(other than parent/legal guardian) 

Name(Required)

First Last

Relationship to student(Required)

Phone(Required)

Your Comments/Questions(Required)

Parent/Legal Guardian Consent

I give my permission for the named minor Delegate to attend the Rotary District 5340 Leadership, Ethics Aspirations & Determination (LEAD) Conference and to participate in all activities related to LEAD. I have read the Statement of Leadership Responsibility below and I ensure that the Delegate, if attending, will be in full compliance. I hereby assume the risk associated with the Delegate’s participation and agree to save, hold harmless, and indemnify Rotary International (RI), RI District 5340, RI District 5340 LEAD Committee members, Rotary Clubs of RI District 5340, Rotarians participating in LEAD, the camp where LEAD is held, and their committees, members, employees, agents, representatives, and volunteers from any and all liabilities, actions, causes of action, medical or other treatment fees, claims, or demands of any kind or nature whatsoever, which may arise in connection with the student’s participation in LEAD. I take full responsibility for any valuables that the Delegate takes to LEAD. These terms shall serve as a release and an assumption of the risk by the Delegate, the Delegate’s parents, heirs, estate, executor, administrator, guardian, and assignees, and all the members of the student’s family. I authorize RI representatives to arrange for professional care and treatment in case of a medical, dental, or other emergency. I give my permission to the physician, dentist, or other professional selected by the RI representatives to provide the treatment deemed appropriate for the Delegate’s wellbeing. I assume responsibility for any medical, dental, or other treatment fees incurred directly or indirectly because of the Delegate’s participation in LEAD. I certify that all the Delegate’s health concerns have been disclosed and that the information provided above is true and correct. I grant RI representatives permission to use the image of the Delegate for educational and promotional purposes. In addition, I grant RI representatives permission to contact the Delegate regarding other RI programs including Interact, Rotaract, speech and music performance contests, and scholarship opportunities. I agree that a copy, including a copy that is scanned, electronically stored, faxed, etc., of this Student (Delegate) Application, including my consent, shall be as valid and enforceable as an original and may be used for all purposes.

Signature(Required)

Date(Required)

This field is for validation purposes and should be left unchanged.