RYLA Registration

Thank you for your interest in the 2025 Rotary Youth Leadership Awards (RYLA)! RYLA is an annual leadership conference intended for aspiring leaders, aged 15-17, to learn new skills, participate in leadership and teamwork activities, and make new friends in the process!

Due to the nature of the conference, the RYLA program may contain sensitive topics for some individuals.

RYLA is an inclusive environment and welcomes all delegates regardless of gender identity, sexual orientation, race or background. The conference will be held May 8th till May 11th 2025, tentatively at Deer Valley Meadows Camp, near Alix, AB. Please fill out this form in its entirety, and feel free to email us at ryla@rotary5360.ca with any questions!

Once submitted, a copy of the application will also be sent to the delegates email. If you do not recieve a copy, something may have gone wrong and we request that you resubmit. Please remember to check junk and spam folders.

Are you sponsored by a Rotary Club?*

YesNoUnsure

Delegate Name*

First NameLast Name

Delegate Pronouns*

She/HerHe/HimThey/ThemOther

Delegate Email Address*

example@example.com

Delegate Phone Number*

Please enter a valid phone number.

Delegate Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Delegate Birthdate*

Date

Delegate Age*

Delegate School attending 2024/25*

Parent/Guardian Name*

First NameLast Name

Relationship to Delegate*

Parent/Guardian Email*

example@example.com

Parent Guardian Phone Number*

Please enter a valid phone number.

Describe why you would like to attend RYLA and what you hope to learn from your experience. (25-200 words)*

0/200

Provide a few examples of your leadership involvement within your school or community. (25-200 words)*

0/200

RYLA will be held from May 8th-11th, 2025, tentatively at Deer Valley Meadows Camp near Alix, AB. Programming will commence Thursday afternoon and conclude on Sunday afternoon. The conference is designed to provide delegates with the opportunity for personal and professional development, while creating long-lasting connections with fellow delegates and RYLA staff. In order for this objective to be met, we require all delegates to be present for the entire duration of the conference. Do you commit to attending RYLA from May 8th-11th in its entirety?*

YesNo

If no, please explain*

Name of Sponsoring Rotary Club*

Name of Rotary Club Contact*

First NameLast Name

Email of Rotary Club Contact*

example@example.com

Phone Number of Rotary Club Contact*

Please enter a valid phone number.

T Shirt Size*

Dietary Restrictions*

Do you have any allergies, medical conditions or required medications?*

Provincial Health Card Number*

Emergency Contact Name (parent/guardian will be contacted first)*

First NameLast Name

Emergency Contact Phone Number*

Please enter a valid phone number.

Relationship to Delegate*

Release, Waiver, and Indemnification

In consideration of RYLA accepting this application and my Child attending the RYLA Conference, I,   First Name*   Last Name*   (“the Parent/Guardian”) the lawful parent/guardian of   First Name*   Last Name*   (“my Child”) of   City/Town*    Province* , do, for my Child, his/her heirs, executors, administrators and assigns, and myself, my heirs, executors, and assigns, hereby acknowledge and give permission on behalf of myself and the said Child to participate in the Rotary Youth Leadership Awards Conference (“RYLA”) held tenatively at Deer Valley Meadows Camp, and hereby release RYLA, Rotary International District 5360 Inc., and the Rotary Club and its respective registered Society sponsoring my Child (“Sponsor Club”), and each of their respective volunteers, servants, agents, or employees (collectively, “Released Parties”), from any claims, demands, damages, actions or causes of action arising out of, or in consequence of, any loss, injury or damage to my Child, or his/her property incurred while attending at, or participating in, RYLA or any related event in which one of the my Child participates, due to any cause whatsoever and notwithstanding that any such loss, injury, or damage may have arisen by reason of the negligence of any of the Released Parties. I further release any recourse I may now, or hereafter, have resulted from any decision of RYLA or the Released Parties in respect of this application.

In consideration of accepting the within application, I the Parent/Guardian of my Child named hereinabove, agree to indemnify the Released Parties from any claims or demands which might be made against the Released Parties arising out of, or in consequence of the attendance or participation by my Child in RYLA.

Transportation: I understand that my Child may be traveling to and from the conference without the supervision of a member of the Sponsor Club. The Sponsor Club will be responsible for arranging transportation either through public carrier or my other means suitable to his/her parents/guardians to and from the conference site. The only activities or transportation that is approved in this program are those activities or transportation which have the sanction of Conference organizers or chaperones. Any participation by my Child in activities or the undertaking of any transportation by my Child which is not so sanctioned shall be at the sole risk of my Child and the undersigned agreement to indemnify the Released Parties for any claim for loss or damage that may be incurred by my Child as a result of his or her participation in such unsanctioned activities or transportation.

I acknowledge and agree that I have had the fullest opportunity to review the contents herein, and to obtain independent legal advice, and I specifically waive my right to independent legal advice, and agree to be bound hereby.

First Name*   Last Name*   (Parent/Guardian)
Signature*   (Parent/Guardian)
Date*

Medical

While Rotary Youth Leadership Awards Conference (“RYLA”), as a program of Rotary International District 5360 Inc., and the Rotary Club and its respective registered Society sponsoring my Child (“Sponsor Club”), and each of their respective volunteers, servants, agents, or employees (collectively, “Released Parties”), provides appropriate supervision, Parents and/or Guardians should be aware of a risk of injury in taking part in RYLA activities. Please complete the following: I,   First Name*   Last Name* being the parent or legal guardian of   First Name*   Last Name*  (participant) do hereby consent to him/her taking part in the activities of RYLA and that he/she may be treated by emergency medical personnel if, as and when required.

First Name*   Last Name*   (Parent/Guardian)
Signature*   (Parent/Guardian)
Date*

Media Consent & Release

*PLEASE NOTE: If the Participant is under 18 years of age, the Participant’s parent or legal guardian must complete and sign this release form.*

I hereby authorize, in the name of   First Name*   Last Name*   (the “Participant”), any images or video footage taken of this youth (under 18 years of age), in whole or in part, individually or in conjunction with other images and video footage, to be displayed on the Rotary Youth Leadership Award (“RYLA”) Program website and other official channels, and to be used for media purposes including informational brochures, promotional presentations, and marketing campaigns. I acknowledge and accept that these materials may be edited at the sole discretion of the RYLA Program. I authorize the display and use of any media material created by my youth within the program.

I waive rights to privacy and compensation, which I may have in connection with such use of my youth’s name and likeness, including rights to be written copy that may be created in connection with video production, editing and promotion therewith.

I am over 18 years-of-age and the parent or legal guardian of the youth, and I have read this waiver and am familiar with its content.

First Name*   Last Name*   (Parent/Guardian)
Signature*   (Parent/Guardian)
Date*

Harassment and Abuse Prevention Policy

As a pre-condition, and in consideration of, the participation of my child,   First Name*   Last Name* , in the RYLA Conference, a program of Rotary International District 5360 Inc., I agree that I, and my child, shall be bound by, and adhere to, this Harassment and Abuse Prevention Policy.

The Rotary Youth Leadership Awards Conference (“RYLA”) is committed to providing to participants as safe a context, both physically and emotionally, as is reasonably possible, where all individuals are treated with respect and dignity. It is RYLA’s position that each individual has the right to participate in a safe and healthy environment which promotes equal opportunities and prohibits discriminatory practices.

Accordingly, RYLA has adopted a zero tolerance approach to the issues of harassment, abuse and discrimination, establishing that they are never acceptable and must not be tolerated . This Policy applies to all employees and volunteers of RYLA, and all of RYLA’s participants, and parents/guardians of participants. Every person aware of abuse, harassment, or discrimination of a child has a positive obligation to report such conduct.

Reports to RYLA may be made by contacting:

Cole Weststrate,

RYLA Chair

ryla@rotary5360.ca

If, in the course of an attempt to resolve a matter under this Policy, information is disclosed regarding harassment, abuse or discrimination of a child under the age specified by applicable legislation, provincial or federal legislation regarding criminal law and child welfare and protection may apply. Procedures under this Policy do not purport to supersede any applicable law. Nonetheless, RYLA retains the right to proceed with a complaint procedure simultaneously with any other relevant proceedings. Nothing in this Policy supersedes or modifies the right of every person who experiences harassment, abuse or discrimination to initiate criminal charges or seek assistance from their provincial or federal human rights commissions, or other appropriate agencies and organizations, even when steps are being taken under this Policy.

It is acknowledged that RYLA reserves the right to terminate the participation of any participant in the RYLA Conference for any conduct it deems contrary to this Policy. This in no way limits RYLA’s rights to do so in other lawful circumstances.

First Name*   Last Name*   (Parent/Guardian
Signature*   (Parent/Guardian)
Date*

As you don't have a Rotary Club sponsor or are unsure, please contact the program coordinator for further information and assistance. Thanks!

ryla@rotary5360.ca

RYLA Registration Form

Waivers