RYLA Application – Draft

The RYLA Plus 2021 Conference will be held Sunday, August 8th through Friday, August 13th.

The deadline for applying is April 1, 2021

Applicant Information

Note: Items denoted with * are required.

First Name

Nickname (If Any)

Last Name

Birth Gender

Preferred Gender Pronouns

Date of Birth

Street Address (1)

Street Address (2)

City

State

ZIP Code

Home Phone

Work Phone

Cell Phone

Email Address

School Name and City

Grade Next Fall

GPA (4.0 Scale)

T-Shirt Type

Adult

Child

T-Shirt Size

Additional Applicant Information

Do you have a Rotary Representative sponsoring you?

Yes

No

How did you find out about RYLA?

Please list any school or outside activites in which you participate:

Please list any leadership positions you have held in your school, club, church, community, or other organizations:

What special talents do you have?

If you have any career or personal goals, please list them here:

Parent/Legal Guardian Information

Parent/Guardian Type

Parent/Guardian Name (First, Last)

Parent/Guardian Telephone

Parent/Guardian Email Address

Additional Parent/Guardian Type

Additional Parent/Guardian Name (First, Last)

Add'l. Parent/Guardian Email Address

Additional Parent/Guardian Telephone

RYLA Plus Application - Terms and Conditions

I, as a parent or guardian of the named applicant, give my consent for my son/daughter to attend RYLA Plus August 8 - August 13 2021. I understand that my camper is expected to attend the entire week and participate fully in the Conference activities.

Check Here To Agree To The Terms and Conditions