Click here for a printable version of the Student Application.


Mail the Printable Applications to:

Rotary Enterprise Summit
C/O: Jackson Rotary Club
P.O. Box 414
Jackson, MO 63755

Or Fax Application to: 573-243-8723

The Rotary Enterprise Summit is a fun, learning opportunity for juniors and seniors from twenty southeast Missouri high schools. Seventy students will be chosen from applicants to attend. Area Rotary Clubs and business sponsorships make it possible to provide this event at no cost to students.

Rotary Enterprise Summit participants will be dismissed from classes all day on Friday, February 4, 2011– 8:00 a.m. until 3:30 p.m.

Four $500.00 scholarships will be awarded to students attending the summit.

Transportation to and from the event will be arranged. Note on page 2 of the application if you need this service.

Students attending the Rotary Enterprise Summit will experience first hand activities designed to focus on the free enterprise system and entrepreneurial processes. Rotarians and other community leaders will serve as mentors and facilitators in this student driven event.

REGISTRATION: Please fill out the application and submit to your school guidance counselor by January 14th. Guidance counselors will submit all applications no later than January 19th to the committee. Students will receive acceptance letters by January 27th, with additional information.


Personal Information

Name
Name for NameTag
Check One
Check One
Check One(T-Shirt Size)
Address
Phone Number
Parent/Guardian Name
Parent/Guardian Phone
School


School Activities
Other Activities
(Scouting,Church,Community,etc.)
Awards,Recognitions
Employment


Medical Consent/Release
Medications
Frequency Taken
Allergies
General Physical Condition
Physician
Phone
Business
Home
Emergency Contact
Phone


Authorization to Provide or Obtain Emergency Treatment
 
I/we hereby authorize personnel of Rotary Camp Enterprise to provide, or act on
my behalf to obtain any medical, dental, or surgical treatment for the above named student, if such personnel believe such treatment is necessary for any reasons. In consideration of THE ROTARY CLUBS’ selection of your child/ward to
participate in Camp Enterprise, the education, fellowship, and recreation that will
be provided to them, I/we hereby release and forever discharge Rotary, its
members and employees, from any claim(s) for injuries sustained by your
child/ward in connection with or arising out of their participation, unless such
injuries are caused by the negligence or willful or wanton misconduct of Rotary, its
members or employees. I/we further agree to indemnify Rotary, its members and
employees and hold harmless from any liability, loss or damage as a result of claims,
demands, lawsuits or judgements made or asserted against them by our child or by
anyone on his or her behalf.



(please be patient after submitting. operation usually takes 5-10 sec.)