Young Citizen Award

Do you know someone under 21 living in the Cheddar Valley who is an inspiration to others, perhaps providing extra help to family, friends and neighbours in our community during the Covid crisis, or providing help and support to charitable causes?


 Rotary Club of Mendip Young Citizen Award Nomination Form 2020/2021
Please read the Privacy Notice overleaf before completing this form. By signing this form, you confirm you have read, understood and agreed to the contents of the Privacy Notice.

  

 

 

Nominee  (please type or use CAPITAL letters)

 

Age on 31st December 2020:

 

Nominee Contact Details

(only to be completed by Nominee  Contact if they are 18 years of age at the time of signing this form and legally eligible to give consent)

Nominee Contact Email:

 

Nominee Tel No:

 

Parent/Guardian Contact Details

  (only to be completed by Parent/Guardian if Nominee is a minor, under the age of 18 years of age at the time of signing this form)

Parent/Guardian’s name and Email:

 

Parent/Guardian’s Tel No:

 

Parent/Guardian address

 

 

 

 

 

 

Please note that, in accordance with the Rotary International in Great Britain & Ireland privacy notice, we  will hold your personal information for the purpose of processing and dispatch of certificates and that this information will be destroyed, along with all other documentation, by 30th  June  2021.

 




 

Completed form must be returned by 31st December 2020 and sent to:

By email (preferred) to Roger Burdock   email  rogerkfburdock@gmail.com

Alternatively forward to:

Roger Burdock at 8, Oaklands, Cheddar, Somerset BS27 3BS. 

 

 

 

Nominees under the age of 18 when this form is completed or who are 18 years of age and over but not legally eligible to give consent, must get a parent/guardian signature to give permission for the following (if the Nominee is 18 years of age, and legally eligible to give consent, when this form is completed, they are giving permission themselves):-

 

a.             for the named Nominee to take part and be identified in the award.

b.             for the information on this form to be used and shared in accordance with the Privacy Notice with appropriate competition/award organisers.

 

 

By signing this form, you are also acknowledging that you have read and agree to the Privacy Notices referred to on the reverse of this form in respect of the use of personal information.

 

*Parent/Guardian/Nominee (Print Name):

 

 

**Signature:

Date:

*delete as appropriate       **Nominee may only sign this form if they are 18 years of age and over and legally eligible on the date the Nomination Form is signed                                                                                                                                                                                   

 

Privacy Notice – Youth Competitions/Awards

 

[For the purpose of this privacy notice, Rotary International in Great Britain & Ireland (Rotary GB&I) also includes Rotary clubs and districts and their members.  The use of the term ‘you’, ‘your’ also means that of your child where the competition/award Nominee is a minor, i.e. under the age of 18 years or 18 years of age and over but not legally eligible to give consent].

 

Members of Rotary International in Great Britain and Ireland (“we”) value the trust you put in us to process your personal information and will always be open and honest about the information we collect and how we will use it. We will never do anything with your personal information that you wouldn’t reasonably expect us to in relation to the Youth Competitions/Awards and we will always take every effort to protect your privacy.

 

The Rotary GB&I Privacy Notice is available on our website, www.rotarygbi.org, and explains how we collect, process and share personal information. This ‘Privacy Notice – Youth Competition/Awards is supplementary to the general RotaryGB&I Privacy Notice and explains in more detail how you can expect your personal information to be specifically used in relation to the Youth Competition/Award events.

 

How we use your personal information for Youth Competitions/Awards

1.      We are collecting your personal information (and that of your child if a minor, or not legally eligible to give consent) for the organisation and administration of the Youth Competitions/Awards only, it will not be used for any other purpose.

2.      Club,or Rotary Public Relations Officers may use your personal information to make contact with you to discuss public relation opportunities and will gain your specific consent at that time for the use of your information, such as photographs/interviews for newspaper articles, club website etc. Where the nominee is a minor, or not legally eligible to give consent, only the parent/guardian will be contacted.

 

Providing your personal information to others for Youth Competitions/Awards

3.      The personal information will only be shared with others that require it for their role/the services they provide for the organisation and administration of the Youth Competition/Award events.

 

4.      Those individuals and organisations that have access to the personal information are also bound by the Rotary GB&I Privacy Notice.

 

Retaining and deleting your personal information

5.      All reasonable steps will be taken by those concerned to ensure the personal information they have access to be kept securely and will not be shared with anyone who does not have a legitimate reason to have access to it in relation to the organisation and administration of the competitions/awards.

 

6.      For all Youth Competitions/Awards, personal information will be kept on file until 30th  June 2021. After this date, the information will be securely destroyed (either by shredding, incineration or deletion from electronic devices).  This timeframe is necessary to allow for any disputes to be settled before the personal information is destroyed. 

 

By signing the front of this form, you are acknowledging that you have read and agree to the Privacy Notices in respect of the use of personal information for yourself (and your child, where applicable).

 

Supporting Information

As the nominating Rotary club, please explain (briefly) on the continuity sheet why you have made, or are happy to endorse, this nomination. Please include any information on the nominated person which demonstrates evidence of ‘good citizenship’ related to this nomination. The nomination should be associated with a current or recently completed project and should state how the young people are actively involved in the project and engaged in ‘acts of citizenship’. 

 

Please attach any photographs, newspaper articles, etc. that usefully support the nomination but don’t rely on newspaper items as the only evidence of work done by the nominee. 

 

Information can include endorsements/statements from the young people’s school or from organisations or people who have benefitted from their help, charity numbers, schemes which are up and running and speaking to those involved. Also obtaining statistics, financial figures if relevant, etc. The nominee can also produce a video of his/her work/project as part of the application, use of a mobile phone is acceptable. 

Rotary will maintain future contact via email.

 

 

ROTARY YOUNG CITIZEN 2021

 

Nomination Form – continuity sheet

 

Name of Nominee: …..…………………………………….

 

Please give an outline as to why the nomination is made – if possible in a typed format