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RYLA 2025 online registration
Event Timing:
January 26th - January 31, 2025
Event Address:
Lakeland Park Camp, 396 Peninsula Rd, Kelvin Heights, Queenstown
Contact us at:
(021) 343 506 or email: d9999rylaqt@gmail.com
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Email
*
Record my email address with my response
** RYLA QUEENSTOWN 2025 **
3pm, Sunday 26th January to
2pm, Friday 31st January
Your Name
*
Your answer
Email
*
Your answer
Home Address
*
Your answer
Mobile Number
*
Your answer
Date of Birth
*
Your answer
Sex: M/F/Other
*
Your answer
T-Shirt Size
(what you would normally wear)
Small / Medium / Large/ XLarge / XXLarge
*
Your answer
Emergency Contact Details:
Name and Mobile Number
*
Your answer
Health:
Do you have any Health / Medical Conditions?
Please include any current medication.
Note: Please be honest with your answers, it will help us respond appropriately should anything arise during your time at RYLA. Your information will be kept confidential.
*
Your answer
Health:
Is there anything we need to be aware of? (ie triggers, phobias, fears)
Note: Please be honest with your answers, it will help us respond appropriately should anything arise during your time at RYLA. Your information will be kept confidential.
*
Your answer
Education:
Tech/University
Courses Taken Or Degrees Obtained
Year Currently in or final Year Attended
Special Awards or Recognitions
*
Your answer
Employment:
Current employer
Position held and are you Full Time or Part Time?
Do you need to ask for time off?
*
Your answer
Hobbies and Interests:
What do you enjoy doing in your free time?
Your answer
Sport, Recreation & Community Activities:
Please List -
Any sporting organisation, Clubs & Hobbies
Any community volunteering groups
*
Your answer
Have you seen the equipment list? Are you able to bring
all
the necessary equipment?
You can ask your Rotary club sponsor to help if necessary.
*
YES
NO ( I will need help from my sponsoring Rotary Club)
Required
You will be sponsored either by a Rotary Club or Employer on to this leadership programme. Briefly, why do you think you are a worthy candidate?
*
Your answer
What do you expect to take away from attending RYLA? Think about where you are in terms of your personal development and what in particular would you like to be included in the programme?
*
Your answer
Describe your level of fitness: 1 - 5 (5 being awesome)
*
Your answer
Who will be paying for you to attend RYLA?
A Rotary Club (please name Club below)
Yourself
Your Employer (please provide details below)
Another Sponsor (please provide details below)
*
Your answer
Dietary restrictions AND/OR Allergies
*
None
Vegetarian
Vegan
Gluten-free
Diary-free
ALLERGIES
Other:
Required
DECLARATION:
Please tick your acknowledgement
I, being the Applicant,
*
understand that I have read the Code of Conduct and will be required to abide by the Code of Conduct and adhere to all the requirements and instructions of the staff at RYLA during my participation in the programme and that in the event of my failure to do so in a reasonable manner I may be returned to my home by the first available transport, with any additional costs so incurred being paid by myself, parents, or guardian.
understand that RYLA 2024 is held in a camp environment and that I will be required to share a single sex cabin/room with others.
in accordance with the Privacy Act, agree to my name and contact details being used on a list of awardees for RYLA follow-up, administration, and Alumni list.
authorise the RYLA Queenstown Operational Committee to use appropriate photos of myself in future presentations or publicity of the RYLA event.
authorise the Chairperson & the RYLA Queenstown Operational Committee, where it is impractical to communicate with me, or to secure my prior consent, to give consent on my behalf to any medical or surgical treatment as may be necessary for my wellbeing and I undertake to meet such cost incurred.
I will email a head and shoulders passport style photo in .jpg or similar format along with this application
understand that if I am no longer to attend RYLA, I must inform the RYLA Organising Committee immediately.
Other:
Required
Thank you for completing this Application Form. If you have any questions, please call Lee-Ann on 021 343 506 or email d9999rylaqt@gmail.com
Someone from the RYLA Organising Committee will be in touch before 1st December to confirm your spot on the course and conduct a short interview.
Your answer
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