2018 RYLA Camper Registration PART II
Please complete and submit this form as soon as possible.
ALSO PLEASE NOTE:
This must be completed by the camper applicant and a parent.
Only submit one fill out and submit this form one time.
Once submitted you will receive a confirmation message- print it and attached to the Registration Part 1 Forms.
Email address *
First Name *
Your answer
Last Name *
Your answer
Name you wish to be called
Your answer
I am being sponsored by the Rotary Club of... *
if you don't know (and can't find out) select other and we will follow up.
Street Address (of camper) *
Your answer
City (of camper) *
Your answer
State (of camper) *
Your answer
Zip code (of camper) *
Your answer
Cell Phone *
Cell
Your answer
Phone Number
Home
Your answer
Email Address *
Your answer
Gender *
Date of Birth *
MM
/
DD
/
YYYY
School you attend *
Your answer
T-shirt Size *
Dietary Preference *
note: check all that apply
Required
Parent/Guardian: First & Last Name *
Your answer
Parent/Guardian: Relation *
mother, father, grandparent, etc
Your answer
Parent/Guardian: Home Phone Number
Your answer
Parent/Guardian: Cell Phone Number
Your answer
Parent/Guardian: Work Phone Number
Your answer
Parent/Guardian #2: First & Last Name *
Your answer
Parent/Guardian #2: Relation *
mother, father, grandparent, etc
Your answer
Parent/Guardian #2: Home Phone Number
Your answer
Parent/Guardian #2: Cell Phone Number
Your answer
Parent/Guardian #2: Work Phone Number
Your answer
Medical Information
Medical Concerns *
Check all that apply and explain below any that are checked
Required
Explain any medical concerns/conditions
Your answer
Allergy Concerns *
Check all that apply and explain below any that are checked
Required
Explain any allergy concerns.
Your answer
Do you have any prescription and/or over-the-counter medications that will be taking to camp? *
Medications
List prescription or over-the-counter medications taken regularly or as needed that will be taken to camp. NOTE ANY THAT ARE EMERGENCY MEDICATIONS
Your answer
Limitations *
Are there any pre-existing medical conditions or other reasons why this camper could not or should not participate in physical activities? (eg. hiking, running, climbing, rafting, etc.)
Explain any pre-existing medical conditions or other reasons why this staff member could not or should not participate in physical activities.
Your answer
Name (Family Doctor) *
If no family doctor, then put N/A for all responses
Your answer
Phone Number (Family Doctor) *
Your answer
Street Address (Family Doctor) *
Your answer
Camper Experiences
List answers to questions to the following 7 question. Please only list top 5 accomplishments/experiences in the last 3 years.
List Academic Accomplishments - Honor Roll, Awards, Accelerated/Special Classes *
Your answer
Other Academic Activities and Recognitions - Positions held & responsibilities undertaken *
Your answer
Sports Participation - Number of years, levels of competition, & any honors *
Your answer
Outside Interests - Hobbies, Recreation, & Community involvement *
Your answer
Work Experience *
Your answer
Leadership Experience – Leadership roles, groups/organizations you served in *
Your answer
Expectations – How/why you will benefit from RYLA *
Your answer
Indicate any Rotary programs that you have been involved with. *
check all that apply
Required
Committee Preferences
Tell us how you would like to share your talents at RYLA.
Select your top 5 committee preferences and rank them 1-5 with 1 being your first choice.
Photo/Slideshow: You will work with other members of this committee in creating a slide show and promo video to be shown at the end of camp. It will be a great way for campers to remember all of the events of the week!
most preferred
least preferred
Newspaper: Extra! Extra! Read all about it! This committee creates newspapers that are distributed to campers and staff. If you have special talents in writing, drawing, cartoons, or predicting the weather, this is the committee for you!
most preferred
least preferred
Community Service: A Committee that is at the heart of RYLA. You will assist with other campers in organizing and facilitating the camp-wide community service project that will be completed during the week of camp.
most preferred
least preferred
Dance : This committee is in charge of RYLA’s camp dance. You and other campers will coordinate the food, decorations, alternative activities, and music to create an evening activity full of fun, fellowship and music!
most preferred
least preferred
Talent Show: It’s a production! This committee creates a showcase for campers to show off their unique talents.
most preferred
least preferred
Make it Meaningful: We know you’re gonna’ love camp. This committee’s purpose is to create something for the campers to remember RYLA, the new skills you learned, and the wonderful new friends you made.
most preferred
least preferred
Alumni/Social Media: Social media is worldwide! This committee works with the various outlets and creates a network of “RYLARIANS”—RYLA Alumni. The Alumni committee orchestrates a RYLA Reunion after camp.
most preferred
least preferred
Thank You: RYLA would not be possible without the help of many people. They will create special “thank yous” to be presented to everyone who works to make camp happen!
most preferred
least preferred
Rotary: This committee conducts a mock Rotary meeting that shows campers how a Rotary Club meeting is run. (There are Rotarians available to answer questions). Also, throughout the week this committee highlights the work that Rotary is doing around the world and how each RYLArian can get involved!
most preferred
least preferred
Camp Rules
These are rules, not mere guidelines. Failure to comply with any of the rules listed below will result in contact with parent/guardian to coordinate removal from camp grounds.

**Please read your responsibilities carefully before initially each item.

1. No prohibited items. Drugs, alcohol, cigarettes and other tobacco products are not permitted on camp premises. Electronics (including cell phones, electronic games, radios, tablets, iPods, etc.) will not be permitted and are not to be brought to camp. Should camp staff encounter any prohibited items at camp, they will confiscate the item, notify the camp directors, and, where appropriate, call the police. Camp directors will hold the items until campers leave, at which time they may claim them. Camp staff is not responsible for the safety, security, or condition of any items brought to camp. *
Initial item once read carefully
Your answer
2. Remain in designated areas. Campers must remain in certain designated areas of the camp during the duration of the camp. If campers are found to be in areas where they are not allowed to enter, the camp directors will remove the campers from the camp. Campers may not visit lodges other than their assigned lodge. Campers should always be with more than one person and at least one staff member at all times. *
Initial item once read carefully
Your answer
3. Full Participation. Every camper must participate in all designated camp activities unless excused by the Camp Director. The activities and seminars at camp are designed to help campers learn and grow. While some may seem new, different, or difficult, every effort has been made to ensure that campers are all safe. To the extent practical, activities and seminars can be modified to meet the needs of all individuals. Should a camper have a concern about an activity or seminar, it is his/her responsibility to voice it to the camp staff. Campers who are unwilling to participate in the designated camp activities detract from the effectiveness of the camp, and will be warned once by camp staff. Continued refusal to participate will result in the camper being removed from camp. *
Initial item once read carefully
Your answer
4. No intimate contacts. Sexual acts or intimate contacts between campers are expressly forbidden. While camp is designed to bring people closer, exclusive relationships are detrimental to the group process. Public displays of affection including kissing, holding hands, and groping which indicate an intimate or exclusive partnership are not allowed. Campers engaging in these behaviors will be warned once by camp staff. Continued defiance will result in the camper being removed from camp. *
Initial item once read carefully
Your answer
5. No aggressive behavior. Verbal or physical aggression towards anyone is not permitted. The camp experience is designed to help campers learn leadership and team building skills. Physical or verbally aggressive behavior is not an appropriate means of communication or problem solving and will not be tolerated at camp. Verbal aggression will be dealt with by camp staff. Camp directors will be notified and effective problem solving strategies implemented. If campers are unable to make peace, or if further eruptions occur, then the campers will be removed from camp. Physical aggression will be reported to the camp directors and campers will be removed from camp. *
Initial item once read carefully
Your answer
A copy of your responses will be emailed to the address you provided.
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