delegate application information - american red cross 5-august 9, 2013 delegate application...

August 5-August 9, 2013

Delegate Application Information

Welcome! Thank you for your interest in participating

in the American Red Cross Leadership Development

Camp as a delegate. A successful camp begins with a

willing delegate who is committed to learning

leadership skills, team building, and about service

through volunteering.

LDC is hosted by the American Red Cross Los

Angeles Region.

Junior and Senior LDC: There will be a junior camp

for middle school delegates and a senior camp for

high school delegates. Both camps will follow

separate schedules during the day and will combine

for nighttime activities and during mealtimes.

Camp Site Information Pilgrim Pines Camp and Conference Center 39570 Glen Road Yucaipa, 92399 Emergency Calls ONLY: (909) 797 – 1821 (909) 790 - 1567

Delegate Fee Scale

Early Bird Discount by May 15: $355

General Tuition by June 20: $395

Late Application by July 12: $445

**Please make checks payable to the American Red Cross

and write “LDC” and the delegate name in the memo section.

We are also providing a credit card authorization form for your

convenience. Deposits are $100 with full payment by the

timeline listed above in order to receive discounts. Deposits

are non-refundable. All camp fees and deposits are non-

refundable after June 20, 2013.

To Apply

Junior Delegates must be entering grades 6-9 in

the fall of 2013. Senior Delegates must be entering

sophomore year of high school up to age 18. All

Senior LDC Delegates must be Red Cross youth

volunteers! Applications are due according to the

fees schedule and must be received by July 12 –

NO EXCEPTIONS! Please plan accordingly if you

intend to submit your application in person or via

post.

Mail Applications

American Red Cross Los Angeles Region

Attn: Leadership Development Camp

11355 Ohio Avenue

Los Angeles, CA 90025

Scan/Email Applications

Jeanne Woo, CVE Associate

[email protected]

Application Deadline

July 12, 2013

For more information Please contact Jeanne Woo Community & Volunteer Engagement Associate (310) 445-2655 [email protected]

August 5-August 9, 2013 CAMP DEPARTURE DAY:

Space is limited, so delegates must register to ride the bus on their application. Bus transportation will be provided to the camp

site on Monday, August 5, 2013 from the West Los Angeles Headquarters of the American Red Cross.

Please arrive no later than 6:30 a.m. and sign in your child, noting the name/phone number of the person who is authorized to pick

them up on the returning day. Breakfast is not provided so please eat before boarding.

*Space is limited so please mark your application if you will be riding on the bus to camp. Full payment of camp fees

MUST be submitted by June 20th

in order to ride the bus. Please note the difference for bus riders and other delegates!!!*

CAMP RETURN DAY:

The buses will be returning on Friday, August 9, 2013 to the West Los Angeles Headquarters of the American Red Cross. Our

estimated time of arrival is 2:30 p.m. Photo IDs will be checked during sign out.

DELEGATE ORIENTATION DATES:

LDC staff will be hosting several Delegate Orientations from June through July at their local Chapters. These orientations will

introduce delegates to LDC and go over what to expect from camp. Registered delegates will receive an Orientation Schedule via

E-Mail after June 20, 2013. If you would like to attend an orientation but did not receive any information about dates after June

20th

, please contact Jeanne Woo, Community & Volunteer Engagement Associate by phone at (310) 445-2655 or by email at

[email protected]

About Leadership Development Camp

WHAT IS LDC?

The American Red Cross is committed to training and empowering youth in our community. Over five days, junior high school and

high school students build confidence and cultivate core leadership skills such as teamwork, public speaking, and diversity/cultural

understanding. These are skills which can later be used on school campuses and in life. As American Red Cross youth volunteers,

staff members create sessions and activities that reinforce delegates’ individual and team leadership skills. Over 100 youth came

back each year as stronger individuals. They form friendships that often last a lifetime. Moreover, they become leaders who make

a difference in their schools and communities.

WHAT MAKES LDC UNIQUE?

LDC is completely planned and staffed by high school and college youth. What is most unique about LDC is that leadership

lessons don’t end on the last day of camp – they continue for the youth who come back to staff the camp, and for those around

them. Youth learn fundraising, marketing, and time management/planning skills. LDC is leadership by youth, for youth. We focus

on core leadership skills first in an active environment. There are no lectures! Sessions and activities are about doing, and that’s a

standard at LDC.

WHAT CAN I EXPECT TO GET OUT OF ATTENDING LDC?

Expect to expand your world by sharing your experiences with youth from all over Southern California. Be prepared to open your

mind and learn something new about yourself and about what’s going on in the world. Discover what you can do to make a

positive impact in your life and in your community.

mailto:[email protected]


Delegate Application Application Deadline – July 12, 2013

Incomplete applications will not be accepted and deposit will not be refunded. Please be sure to complete the entire application

before submitting it.

Delegate Fee – Early Bird Discount $355 ($100 deposit and $255 remaining by May 15); General Tuition $395 ($100 deposit

and $295 remaining by June 20); Late Application $445 ($100 deposit and $345 remaining by July 12). Deposits are non-

refundable. All applications and fees must be received by July 12, 2013 – No exceptions!

Delegate Information

First Name Last Name Preferred Name Gender

Address City/Zip Date of Birth

Email Address Home Phone Cell Phone

School attending in the Fall Grade in the Fall Ethnicity Age

Red Cross Chapter Affiliation Food Preferences (and/or allergies) T-Shirt/Sweatshirt Size

Have you attended LDC? (List years) What camp will you be attending (Junior or Senior)?

Will you need to ride on the bus? (Limited Space available!)

☐ Yes ☐ No

School and Extra Curricular Activities

Please list any school and extra-curricular activities you are involved with this year

Name of Activities Description and Time Commitment Level


Red Cross Training and Service Projects

Please list any Red Cross Training you have received and list Red Cross Service Projects you participated in

Training Service Projects

Questions for ALL Staff

Please answer the following questions in the space provided.

1: What motivated you to apply as a delegate for Leadership Development Camp 2013?

2: What are your expectations of LDC 2013 and what do you hope to gain from your experience at camp?


3: Describe a time in your life where you took a lead on something OR a time when you made a difference?

Please list any last thoughts or qualifications that you would like us to know when considering accepting you as an LDC 2013 delegate.

Signatures

I have read, understand and received a copy of the

Delegate application and Leadership Development Camp

rules for the 2013 LDC. I have reviewed the application

deadlines and other required dates and there are no known

conflicts with any listed. I fully understand that inability to

fulfill these commitments could result in being released as

a Delegate. To the best of my knowledge all statements in

this form are true, and any misrepresentation will call for

immediate dismissal. I acknowledge the above information

is voluntarily supplied and may be used and disclosed for

Red Cross purposes only. Finally, I agree to abide by the

policies and procedures of the American Red Cross.

Applicant Signature

Print Name

Date

Applicants under 18 must have parent’s signature

As the parent of I have

carefully reviewed the requirements and commitments

necessary for my son or daughter to serve as a Delegate

for LDC 2013. I fully support my son or daughters desire to

participate and give my permission to do so. I understand

that if my son or daughter cannot fulfill the commitment to

attend camp in its entirety and behave according to the

expectations for delegates, this may be cause for their

dismissal from LDC 2013 and will result in forfeiture of any

camp fees.

Parent Signature

Print Name

Date


AMERICAN RED CROSS LIABILITY WAIVER

(For events involving adult and minor participants)

I/my minor child, wish/es to participate in the Leadership Development Camp orientations at local Red Cross Chapters and summer camp to be held at Pilgrim Pines in Yucaipa, CA August 4-9, 2013. I am aware that participation in the Activity is potentially hazardous and entails a risk of physical injury. I understand and agree that I/my child am/is electing to participate at my/his/her own risk. I am not aware of any physical or medical condition that would interfere with my/my child’s ability to participate. IN CONSIDERATION OF MY/MY CHILD BEING PERMITTED TO PARTICIPATE IN THE ACTIVITY, I HEREBY RELEASE AND DISCHARGE THE AMERICAN NATIONAL RED CROSS, AMERICAN RED CROSS GREATER LONG BEACH CHAPTER, AND GREATER LOS ANGELES CHAPTER AND ALL OF THEIR EMPLOYEES, VOLUNTEERS, OFFICERS, AND AGENTS (“RELEASEES”) FROM ANY AND ALL CLAIMS FOR PERSONAL INJURY, DEATH, OR PROPERTY DAMAGE ARISING FROM OR IN ANY WAY CONNECTED WITH MY/MY CHILD’S PARTICIPATION IN THE ACTIVITY, EXCEPT WHERE THE SAME IS CAUSED BY THE WILLFUL MISCONDUCT OR GROSS NEGLIGENCE OF THE RELEASEES. For parents/guardians of minor participants only: As the minor’s parent/guardian, I hereby consent to his/her participation in the Activity. If my child is injured or becomes ill and neither I nor the other parent/guardian can be reached at the numbers below, I give the American Red Cross permission to seek medical attention for my child. BY SIGNING THIS WAIVER, I AFFIRM THAT I HAVE READ AND UNDERSTAND IT AND AGREE WITH ITS CONTENTS. _________________________________________________________ _______________________________ Signature of Participant (over 18) or, if Participant is a minor, Date the Participant’s Parent/Guardian _________________________________________________________ Printed Name of Participant (over 18) or Participant’s Parent/Guardian

Photo Release I understand that I/my child may be photographed during the course of the Activity. I grant full and unlimited permission to the American Red Cross, and their agents and affiliates to use my/my child’s name, photographs or any other record of participation in this Activity in any broadcast, telecast or other account of the Activity for publicity purposes, without compensation, by placing my initials here. _________

Emergency Contact Information (To be provided by parent/guardian of minor participant)

Parent/Guardian/Emergency Contact 1:

Name:

Relationship:

Daytime:

Evening:

Cell:

Email:

Physician Name:

Parent/Guardian/Emergency Contact 2:

Name:

Relationship:

Daytime:

Evening:

Cell:

Email:

Physician Phone:


Credit Card Payment Form

Delegate and Payment Information

Delegate First Name Delegate Last Name Date

Name on Card Credit Card # Exp. Date Security Code

Billing Address City/Zip Phone Number

Card Holder Signature Date Notes

Please charge my credit card:

□ $100 Non-Refundable Deposit only □ $100 Non-Refundable Deposit now

and balance by ________________, 2013

□ $________ Delegate Fee – Paid in

Full now

I would like to make a Tax-Deductable Donation to the LDC Scholarship Fund to help fund delegates and staff in need of financial assistance.

□ $_________ □ $25 □ $50 □ $100 □ $210 □ $_______ I would like to give Assist with partial scholarships Staff scholarship Delegate scholarship

Please complete and return with your application to:

American Red Cross Los Angeles Region

Attn: Leadership Development Camp

11355 Ohio Avenue

Los Angeles, CA 90025

Delegate Fees

All perspective delegates must turn in their $100 non-refundable deposit with their application (will be returned if not selected)

and submit remaining balance according to fees schedule and no later than July 12, 2013.

**Please make checks payable to American Red Cross and write LDC & staff name in the memo section on all checks. We have

also provided a Credit Card Authorization form, for your convenience. Deposits are non-refundable unless the applicant is not

accepted as a delegate. Delegates failing to meet the orientation and behavior expectations will not receive a refund on any camp

fees. All camp fees and deposits are non-refundable after July 12, 2013.

delegate application information - american red cross 5-august 9, 2013 delegate application...

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