RYLA 5580 Student Registration
Student deadline is April 30
Student Information
Name
*
First Name
Last Name
Preferred First Name
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Preferred Pronouns
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
T-shirt Size (Gender Neutral)
*
Please Select
Small
Medium
Large
X-Large
XX-Large
XXX-Large
XXXX-Large
School Information
Current High School
*
Current Year in High School?
*
Sophomore (Grade 10)
Junior (Grade 11)
Other
Sponsoring Rotary Club
*
Please Select
Unknown - Please help me find mine.
Ashland
Bagley
Baudette
Bemidji
Bemidji Sunrise
Bismarck
Bismarck Far West
Bowman
Brainerd
Brainerd Lakes Sunrise
Central Lakes
Cloquet
Crookston
Detroit Lakes Breakfast
Detroit Lakes Noon
Devils Lake
Dickinson
Duluth
Duluth Harbortown
Duluth Skyline
Duluth Superior Eco
East Grand Forks
Ely
Fargo Moorhead AM Rotary Club
Fargo Rotary Club
Fargo West
Fergus Falls Noon Rotary
Fergus Falls Sunrise
FM PM
Fosston
Grand Forks Breakfast
Grand Forks Downtown
Grand Forks Noon
Grand Rapids Centennial
Grand Rapids Evening
Hibbing
Hibbing - Chisholm
International Falls
Iron Range Rotary
Jamestown
Long Prairie Rotary Club
Minot Noon
Minot Sunrise
Missouri River
Moorhead
Nipigon Rotary Club
North Shore
Park Rapids
Pelican Rapids
Perham
Staples
Superior Rotary
Thief River Falls
Thunder Bay Lakehead
Thunder Bay Fort Williams
Thunder Bay Port Arthur
Wadena
Wahpeton Breckenridge
Walker
Watford City
Williston Rotary
Application Questions
What do you hope to learn at Rotary Youth Leadership Award (RYLA) Camp?
*
How do you want to use new leadership skills after RYLA?
*
Emergency Contact Information
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
I agree to participate completely in Camp RYLA, starting at 1:00 pm July 14 - 11:00 am July 20. I will submit my application to my school counselor or the Rotary Club that will be sponsoring me. After acceptance into the program, a Parent/Guardian will need to complete a medical & liability waiver which will be sent by RYLA.
I agree
Submit
Should be Empty: