2024 RYLA Student Application

2024 RYLA Student Application

Please Note - If you attended RYLA in the past, you will be added to the waiting list to allow other students who have not had the opportunity to attend. Application submitted after Oct. 18th will be put on the waitlist
Student Information
Name*

First NameLast Name
Name of School*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number*
Please enter a valid phone number.
Student Email (Primary Contact Email)*
example@example.com
Emergency Contact*

First NameLast Name
Emergency Contact Relationship*
Emergency Phone Number*
Please enter a valid phone number.
T-Shirt Size (unisex)*
Please list any dietary restrictions*
Medical Restrictions

If you have any medical restrictions, please contact the RYLA chair at inezrodenburg_rotary@yahoo.com
Age on Dec. 6, 2024*
Class*
Gender*
Are you currently in an Interact Club*

YesNo
Are you a foreign exchange student*

YesNo
Will you be participating in the Four-Way Speech Contest*

YesNo
Have you previously participated in RYLA. Please note that preference is given to students who have not attended RYLA.*

YesNo
Please list High School Activities*
Please list Community Activities*
Please list Recognition, Honors and Awards*
How did you hear about RYLA?*
Please share any details you believe would be beneficial for the RYLA Chair to be aware of in order to facilitate a supportive and inclusive experience for you.

Rotary Club Information

Please Note - Please ensure Rotary contact name and email is correct. These contacts will receive email notification upon your submission.
Name of Sponsoring Club*
Name of Rotary Contact*

First NameLast Name
Phone Number of Rotary Contact*
Please enter a valid phone number.
Email of Rotary Contact*
example@example.com
Transportation

All adults transporting students must have a Rotary background check. If you know who will be transporting the student(s), please complete the information below. This information is required by Nov. 24, 2024. Please note that students cannot transport themselves to RYLA.
Name of adult transporting student to RYLA

First NameLast Name
Email of adult transporting student to RYLA
example@example.com
Phone Number of adult transporting student to RYLA
Please enter a valid phone number.
Name of adult picking up student from RYLA

First NameLast Name
Email of adult picking up student from RYLA
example@example.com
Phone Number of adult picking up student from RYLA
Please enter a valid phone number.

Waiver Forms

Please print out both forms, sign, and submit
Student Participation Form
Student Assurance Form
Signed Student Participation Form*

Cancelof
Signed Student Assurance and Parent Guardian Permission Form*

Cancelof
Payments

Student applications - $350 Exchange Student application - $225. Clubs will be invoiced after students have been approved.
Application Deadline - October 14, 2024

As a student I understand that my sponsoring club is paying for all fees associated with RYLA. I also understand that refunds will not be provided after October 31, 2024. By submitting my application I am committing to attend RYLA Dec 6-8, 2024
Student Acceptance

I attest that the information provided above is correct and accurate and I attest that I have received approval from my sponsoring Rotary Club to participate in RYLA Dec. 6-8, 2024. I understand that my application will be received and reviewed by my sponsoring club for final approval.
Application Notification

Applications are reviewed by the sponsoring Rotary Clubs. Students will be notified once their application has been approved.
Application Deadline - October 14, 2024.

Applications received after October 14th will be put on a waiting list.
Approval
Should be Empty:

Student Information