Rotary Youth Leadership Awards

February 10-12, 2023

Florida Sea Base, Islamorada FL

RYLA is a life-changing leadership training program where young people learn, develop, and enhance leadership skills and principles in an atmosphere of trust and respect. RYLA encourages and assists current and potential youth leaders in methods of responsible and effective leadership.

Students who are currently high school sophomores or juniors may apply to participate.

Every attendee is sponsored by a Rotary Club. The application process is competitive, and we cannot automatically accept every applicant into the conference. This is an award and there is no cost to the students to participate.

RYLA runs all day Friday, February 10 through Sunday, February 12th so it will be necessary to be absent from school on Friday, Feb. 10. Participants cannot arrive late or depart early.

DO NOT APPLY IF YOU CANNOT COMMIT TO ATTENDING THE ENTIRE CONFERENCE.

Bus Transportation is provided for Broward and Miami-Dade Students.

Each RYLA Participant must agree to follow Sea Base health guidelines.

For more information email: District6990RYLA@gmail.com

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RYLA 2023 Application

This application form must be completed in full and signed by both the student and a parent or legal guardian in multiple places. Incomplete forms will delay (or preclude) application for RYLA.

This application form must be completed and submitted NO LATER THAN DECEMBER 15, 2022.

NOTE: At any time during completion of this application form,
you can save your work and return if you need time to gather information.

Create Account to enable save and return function. (optional)

You may save your progress with GREEN BUTTON at bottom of form and complete later. Returning to finish application? Use login button.

Team # : Leave Blank

Admin: Leave Blank

Sponsoring Rotary Club *

First Name *

Last Name *

Preferred Name for Name Tag *

Street Address *

Apartment #

City *

State/Country *

Zip Code *

Student Cell Phone *

Student Email Address *

Parent/Guardian Name *

Parent Phone *

Parent Email Address *

Parent/Guardian #2 (if applicable)

Parent #2 Phone

Parent #2 Email Address

Alternate Emergency Contact (optional)

Alternate Emergency Contact Phone

Birthdate *

Gender *

M

F

Preferred Pronouns *

High School *

Grade *

How did you hear about RYLA? *

List Current Activities and Achievements (sports, clubs, projects, job, volunteer work): *

Why do you want to participate in RYLA? *

What are the challenges or obstacles to you reaching your leadership goals? *

Upload Photo of Applicant (headshot) *

This application form must be completed and submitted NO LATER THAN DECEMBER 15, 2022

Parental Authorization and Release

Date *

Student Name *

PARENTAL AUTHORIZATION:

I consent to my son’s or daughter’s participation in all RYLA activities to be held at Florida Sea Base in Islamorada, FL on February 10-12, 2023. I assume responsibility for any medical or treatments fees or costs incurred directly or indirectly because of said minor’s participation.

I also authorize the representative(s) of Rotary District 6990 to arrange for professional care and treatment in case of a medical emergency. I hereby give my permission to the physician selected by the Rotary representative to hospitalize and secure professional treatment for the minor named above.

RELEASE, ASSUMPTIONS OF RISK AND AGREEMENT TO HOLD HARMLESS

In consideration of the sponsoring Rotary Club, Rotary International District 6990, I permit my child to participate in RYLA and to engage in all related activities. I hereby assume the risk associated with participation and agree to hold Rotary District 6990, the sponsoring Rotary Club, Rotary International, representatives and volunteers harmless from any and all liabilities whatsoever that may arise by or in connection with my child’s participation in any activities related to RYLA.

I grant Rotary District 6990 and the sponsoring Rotary Club permission to use the image of the above-named minor for educational and promotional purposes.

Printed Name of Parent or Guardian *

Signature of Parent or Guardian *

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This application form must be completed and submitted NO LATER THAN December 15, 2022

RYLA Rules and Code of Conduct

Date *

Student Name *

I understand and agree that:
- No tobacco, alcohol, drugs, or vaping devices are allowed on the premises.
- Smoking is not permitted at any time.
- Students are not permitted off-site at any time.
- No boy/girl co-mingling in dorms at any time.
- All students participating in RYLA must follow the Sea Base health guidelines that may be in force at the time of the conference, including COVID-19 protocols.
- Students must attend the entire conference and cannot arrive late or leave early.

RYLA Non-Discrimination Policy

RYLA is committed to providing all students with a safe and supportive environment free from discrimination on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, or sexual orientation in all of its activities and operations.

RYLA Youth Protection Policy

Rotary International's Statement Conduct for Working with Youth

Rotary International strives to create and maintain a safe environment for all youth who participate in Rotary activities. To the best of their ability, Rotarians and other volunteers must safeguard the young people they come into contact with and protect them from physical, sexual, and emotional abuse.

Student signature *

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Before you SUBMIT this application, please review and print a copy for yourself.
[To Print: Contrl+P or Right-Click, select Print]

For more information email: District6990RYLA@gmail.com