2026 RYLA 5580 Camper Application

RYLA 5580 Student Registration

The deadline to submit your application is March 31, 2026. All information submitted through this form is securely encrypted to protect your privacy.
Student Information
Legal Name*

First NameLast Name
Preferred First Name
Date of Birth*

MonthDayYear
Date
Gender*
Pronouns*

he/himshe/herthey/themprefer not to sayother
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
T-shirt Size (Adult Gender Neutral Sizing) *
Please list any dietary requirements.
School Information
Current High School*
Current Year in High School?*

Sophomore (Grade 10)Junior (Grade 11)Other
Sponsoring Rotary Club*
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 NameLast Name
Relationship to student
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 12, 2026 - 11:00 am July 18, 2026. After acceptance into the program, a Parent/Guardian will need to complete a medical & liability waiver which will be notarized and sent to the RYLA Team.

I agree
Should be Empty:

RYLA 5580 Student Registration