2026 RYLA Chaperone Application

2026 RYLA Chaperone Application
Name

First NameLast Name
Name of Sponsoring Club
Select One
Name of School
Type NA if school unknown
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name of Emergency Contact (someone who will not be with you at RYLA)

First NameLast Name
Emergency Contact Relationship
Emergency Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Please select all current certifications or qualifications
Please list any current medical certifications or healthcare qualifications you hold. This information will be used to identify chaperones who may be able to assist in the event of a medical emergency.
Type "None" if None
T-Shirt Size (unisex)
Occupancy (for double occupancy, please include name of roommate)
Name of Roommate * Include if selected Double Occupancy

First NameLast Name
Gender
Dietary Restrictions (select all that apply)
Please explain any food allergies
Type "none" if none
Have you experienced any of the following (select all that apply)
Please describe any conditions that staff and fellow chaperones should be aware of in the event of an emergency.
Have you volunteered as a chaperone in the past?
Standards of Behavior for RYLA Chaperones

Since RYLA is sponsored at the Inn at Virginia Tech and Skelton Conference Center, all volunteers must sign the Virginia Tech Standards of Behavior. The form can be found here. Please print and submit.
Standards of Behavior Form

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How did you hear about RYLA
RYLA Chaperone Participation

By submitting your RYLA Chaperone Application, you agree to participate in all RYLA activities throughout the weekend, complete room checks for assigned students, mentor and engage with students, ensure students abide by the student code of conduct, and agree to assist with any programming needs.
Payment

Once your application has been approved, your Rotary Club will be invoiced for the full amount. Once your application has been approved, we will be sending you information to complete your background check.
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2026 RYLA Chaperone Application

RYLA Chaperone Participation

Payment