Young RYLA 2022 Application Form – Rocky Mountain RYLA

2022 Young RYLA Application

Step 1 of 2

Name(Required)

First Nickname (If Any) Last

Date of Birth(Required)

Identified Gender(Required)

Female

Male

Pronouns

Shirt Size(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Applicant Email(Required)

*** Important *** Please DO NOT use an email address provided by your school. For security purposes many schools block emails to students that do not originate from someone else with an email address from the same school or school district.

Enter Email Confirm Email

Primary Phone(Required)

Please provide the best telephone number for us to use to reach you.

Can you receive SMS/Text messages at this number?

Yes

Mobile Phone

Young RYLA Conference Preferences

Please identify your Young RYLA Conference preferences. We try our best to match accepted applicants with their preferred attendance plans, but we do not guarantee we will be able to meet every accepted applicant's preference.

Please choose your conference preferences(Required)

Young RYLA Week 1 ONLY (Sun-Fri, JUNE 19-24, 2022)

Young RYLA Week 2 ONLY (Sun-Fri, JULY 24-29, 2022

Either week, but I prefer Week 1 (Sun-Fri, JUNE 19-24, 2022)

Either week, but I prefer Week 2 (Sun-Fri, JULY 24-29, 2022)

If your application is sponsored by a rotary club, select the club here:

Other/Not Listed Rotary Club Name

Is your application sponsored by some other organization?

Yes

Sponsoring Organizaion Name

Your School(Required)

After selecting the appropriate option, you can use the dropdown boxes below to choose your current school. First select the state where your school is located. Next, choose the city where the school is physically located. Lastly, select the school. If you are Home Schooled, choose "HOME SCHOOLED" as your school's city, and If your school is not listed, choose "Unlisted" for City, and "Unlisted" for your school. You will have the opportunity to enter your city and school manually.

My school is in Colorado, Nebraska, or Wyoming

My school is in another state or country

School State(Required)

The State where your school is located.

School City(Required)

The city where your school is located. If you are home schooled, choose the "Home Schooled" option. Choose "Unlisted" if you can't find the correct city.

School Name(Required)

Choose your school. If you selected the correct city and your school isn't listed, change the city to "Unlisted" and fill in the City and School Name in the boxes that will appear below.

Unlisted School State(Required)

Unlisted School City(Required)

Unlisted School Name(Required)

Current School Grade(Required)

7th Grade

Young RYLA is open to 7th grade students (or equivalent).

Parent/Legal Guardian Information

Parent or Legal Guardian consent is required to attend RYLA. Please provide contact information that we can use to communicate with your parent/legal guardian in order to gain their consent for your particpation.

Parent/Guardian Name(Required)

First and Last Name (ex: James Smith)

Parent/Guardian Type(Required)

Parent

Legal Guardian

Parent/Guardian Phone(Required)

Parent/Guardian Email(Required)

Enter Email Confirm Email

Emergency Contact Information

Emergency Contact Name(Required)

Emergency Contact Phone(Required)

Additional Information

Please describe any school-related activities in which you participate:

Please list any of your other (outside of school) interests and activities:

What interests do you have that you have been unable to pursue because of lack of opportunity or other barriers?

Would you like to include a photo of yourself with your application?

Yes

Upload Your Photo

Accepted file types: jpg, jpeg, png, gif.

Agreements

Parent/Legal Guardian Approval Required(Required)

I understand that a parent or legal guardian must consent to my participation in Young RYLA, and I have provided current, accurate contact information for my parent/legal guardian.

Application does not guarantee participation(Required)

I understand that submitting this application is just the first step of the Young RYLA application process, and that submitting this application does not guarantee me an attendance slot at the Young RYLA conference.

No partial conference attendees(Required)

Young RYLA is a 6-day conference, and all participants must arrive ON TIME and stay for the ENTIRE conference. With the exception of emergencies, late arrivals and early departures are NOT PERMITTED. By submitting this application, I understand and agree to this policy.

Conformance with health and safety requirements(Required)

Every Young RYLA Participant who is eligible under CDC Guidelines to receive a COVID-19 vaccination must be fully vaccinated (including boosters, if eligible) in order to attend Young RYLA. Additionally, all participants must abide by any other health-related requirements that may be established by Rotary International, Rocky Mountain RYLA, Larimer County, and YMCA of the Rockies, such as the wearing of face masks, being subjected to COVID-19 testing, etc. I understand I will not be permitted to participate in Young RYLA if I am unable or unwilling to comply with these requirements.

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Application Status

Hidden

Sponsoring Club

Rotary Club providing slot

Hidden

Additional Notes/Information

Enter any additional information about this applicant.

2022 Young RYLA Application

Young RYLA Conference Preferences

Parent/Legal Guardian Information

Emergency Contact Information

Additional Information

Agreements

Please Review Your Application Before Submitting (Or Saving)