RYLA 2027 - Volunteer Registration

RYLA 2027 - Volunteer Registration

Completion of the Rotary International Youth Protection Course is required for all volunteers. The link to the RI Youth Protection Course is on the Rotary 5910 RYLA webpage under the Rotary Learning Center.
Rotary Club Name
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Gender
Emergency Contact

First NameLast Name
Emergency Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
List Dietary Restrictions
Be aware that limited food preferences can be accommodated
T-Shirt Size
Jacket Size
(For Counselors & Trainers Only. NOTE - A camp store will be available for Adults to purchase gear)
Do you need overnight accomodation?
Arrival Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Departure Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Did you volunteer with D5910 RYLA in 2026 or another year previously?
Are you 18 or older
Birth Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
If you are over 18, do you understand that you have to have a Background Check?
Do you have a valid Drivers License?
Drivers License State of Issue
License ID number
Please enter name and phone number for Primary/General Practitioner.
List and explain any health conditions or physical limitations of participant (e.g. asthma, recent injuries limiting mobility, crutches, etc.):
Participant has known allergies.
List allergies, if any:
Participant needs medications (prescription and over the counter) administered while attending (Only required for Counselors and Trainers – Adult Volunteers may request this assistance, but not required). RYLA IMPORTANT: ALL MEDICATIONS MUST BE IN THE ORIGINAL CONTAINER. MEDICATIONS WILL BE ADMINISTERED BY MEDICAL STAFF AND MUST BE GIVEN TO THE STAFF MEMBER AT REGISTRATION WITH ANY SPECIAL DISPENSING GUIDELINES.
Medication One Name | Dosage | Frequency (e.g. with lunch, at bedtime, as needed)
Medication Two Name | Dosage | Frequency (e.g. with lunch, at bedtime, as needed)
Medication Three Name | Dosage | Frequency (e.g. with lunch, at bedtime, as needed)
I understand that RELEASEES will not be responsible for any medical costs associated with an injury sustained by the participant.
The participant / I further agree to become familiar with the rules and regulations of the camp and program concerning student conduct and not to violate said rules of any directive or instruction made by the person or persons in charge of set activity and that I will further assume the complete risk of any activity done in violation of any rule or directive or instruction.
Your written authorization is necessary for completion of your application to be a RYLA Volunteer.

I, ____________, hereby authorize Rotary District 5910 RYLA to investigate my background and qualifications for purposes of evaluating whether I am qualified for the volunteer position for which I am applying. I understand that RYLA will utilize VeriFYI to assist it in checking such information, and I specifically authorize such an investigation. I also understand that I may withhold my permission and that in such a case, no investigation will be done, and my application RYLA will not be processed further.

All personal information released by the applicant as well as received through VeriFYI will be kept confidential and will only be released to the District 5910 Youth Protection Officer and the district 5910 RYLA Chair.
Signature
Print Name
Completion of the Rotary International Youth Protection Course is required for all volunteers. The link to the RI Youth Protection Course is on the Rotary 5910 RYLA webpage under the Rotary Learning Center. Rotarians will need to log into their MyRotary Account before accessing the course. ALL non-Rotarian volunteers will need to create a MyRotary Account and be logged into it before accessing the course. All volunteers must upload their Protecting Youth Program Participants certificate of course completion. To access the course, create a myRotary account, or upload your certificate, go to https://rotary5910.org/sitepage/ryla
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