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RYLA 2022 APPLICATION FORM
SATURDAY 2ND JULY 2022 - SATURDAY 9TH JULY 2022
WILLOWPARK CONVENTION CENTRE - 1 HOSTEL ACCESS ROAD, EASTERN BEACH

ALL FIELDS ARE MANDATORY – PLEASE PUT N/A IN A FIELD THAT DOES NOT APPLY TO YOU.

YOU WILL RECEIVE A COPY OF THIS FORM ONCE COMPLETED. YOU HAVE UNTIL 30TH APRIL 2022 TO GO BACK AND UPDATE ANY FIELD.

Welome to the RYLA registration page. Prior to commencing this application ensure you have read the Code of Conduct and the List of Necessary Equipment which can found under the Documents menu item.

You will need to complete this online application in one sitting. Therefore ensure you have ALL the necessary information at hand. Do not navigate away from this this page or close your browser while filling out the registration form.

Upon submitting this application you will receive a confirmation email together with your application (which you may revise until 30th April 2022). Your application will be received by the district Registrations team and it will be forwarded to your nominated Rotary club to arrange an interview. If a Rotary Club is not nominated a member of the Registrations team will contact you and select an appropriate club to get in contact with you and conduct the interview.

If you do have problems completing this application, feel free to contact RYLA at applications.ryla@gmail.com.

Please note that every field in the below form is required. The form will not submit if there are any empty fields.
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Email *
PERSONAL DETAILS
APPLICANTS ACCEPTED ONTO THE RYLA COURSE WILL BE INVITED TO A CLOSED FACEBOOK GROUP AHEAD OF THE COURSE TO RECEIVE UPDATES AND IMPORTANT INFORMATION.
Surname *
Given Name(s) *
Preferred Name *
Address *
Town / City *
Mobile Phone *
Facebook Email (if different from above) *
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Shirt Size (unisex) *
EMERGENCY CONTACT INFORMATION
PLEASE PROVIDE DETAILS OF WHO TO CONTACT IN THE UNLIKELY EVENT OF AN EMERGENCY.
CASUAL ASSOCIATES, FLAT MATES, ETC. ARE NOT ACCEPTABLE.
Contact Name *
Relationship to applicant (e.g Mother) *
Mobile phone (emergency contact) *
HEALTH & MEDICAL
FOR THE SAFETY OF ALL CANDIDATES, ALL MEDICATION MUST BE DISCLOSED TO THE RYLA ORGANIZING COMMITTEE, THIS INFORMATION WILL REMAIN CONFIDENTIAL AND ONLY SHARED WITH MEDICAL STAFF RELEVANT TO THE PROGRAM, EDIT THIS IS NOT CORRECT YET
Dietary Restrictions (Medical and Religious only) *
Required
Health Issues *
Current medication(s) or N/A *
Fitness Activity *
OCCUPATION
IN THIS SECTION YOU WILL BE ASKED TO IDENTIFY THE CORPORATE/BUSINESS YOU WORK FOR
Current employer *
Current position *
Have you been asked to complete this application form by *
Rotary Club name or N/A *
GENERAL
Describe your Leadership style, with examples *
What do you personally want to get out of RYLA? *
Summarise what have you been up to in the last five years *
Additional personal statement *
Are you able to bring to RYLA all the necessary equipment on the Compulsory Gear List? *
Have you read the Code of Conduct for RYLA 2022? *
DECLARATION
Please read the full declaration fully and confirm your agreement as such to be considered for RYLA 2021

I, INSERT NAME BELOW being the Applicant,
• understand that I will be required to abide by the Code of Conduct and adhere to all the requirements and instructions of the director and staff of 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 is held in a camp environment and that I will be required to share a single sex dormitory 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 and administration purposes including these details shared within Rotary for the purposes of future communication of related content, course or alumni project information.
• in accordance with the Privacy Act, agree that any photos taken of me during the course may be used by RYLA (Rotary) for the further promotion of future RYLA courses.
• I authorise the Chairman – RYLA Operational Committee, where it is impractical to communicate with me, or to secure my prior consent, to consent on my behalf to any medical or surgical treatment as may be necessary for my well-being and I undertake to meet such cost incurred, furthermore I agree to undertake as requested by course leadership any temperature check and or Covid related test that may be required at the time relevant to the country's alert or threat level.
INSERT NAME OF APPLICANT MAKING DECLARATION *
APPLICANT DECLARATION - BY INDICATING YES BELOW I DECLARE ELECTRONICALLY AGREEMENT WITH THE DECLARATION DETAILS ABOVE. *
A copy of your responses will be emailed to the address you provided.
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