2015 RYLA - Rotary District 5730
Application Deadline - May 22, 2015
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Please complete the  APPLICATION form below for the RYLA 2015 Leadership Program to be held June 21-25, 2015 at South Plains College in Levelland, Texas.  Come learn leadership and life skills to create a successful life that makes a difference. All while having good fun with high quality students from around West Texas.
Name *
Your legal first name (William, Rebecca, Charles, etc.)
Badge Name
Leave blank if you go by first name.
Last *
Legal last name.
Attended RYLA in a previous year?   *
Students may only attend RYLA one time as a Camper.
Gender *
Grade Next Year *
Students MUST be a Junior or Senior in the fall of 2015.
Email address *
You MUST submit a working email address to receive an application for RYLA.
Comfirm Student Email *
Date of Birth *
MM
/
DD
/
YYYY
Phone # *
Student cell phone number or another working contact number. (no symbols please 8175336792)
Parent *
Enter your parent or guardian's full name.
Emergency contact *
Preferably a parent.
Alternate Phone number *
Student home phone number or another working phone contact number. (no symbols please 8175336792)
Parent Work Phone
This is optional. (no symbols please 8175336792)
Parent Cell Phone
This is optional. (no symbols please 8175336792)
Home Address *
EX: 1224 W. Main St.
City *
TEXAS *
Zip Code *
EX: 76033
High School *
School you are attending now.
Small *
What size T-Shirt do you wear?
Sponsoring Rotary Club
If a local Rotary Club invited you to apply, please list the name of the club (Amarillo West, Big Spring, Lubbock, Midland Downtown, etc.). An invitation is not required to apply.
Why Leadership *
Why do you want to learn more about Leadership?
Agree to attend *
If your application is accepted, a local Rotary Club will pay a sponsorship fee of $425 to secure your spot for RYLA 2015, June 21-25 (Sunday afternoon through Thursday afternoon). If you have a conflict such as a vacation, another camp, or summer sports, please DO NOT complete this application.
Thank you for your interest!
To attend you will also need to fill out a Medical Form and a code of conduct statement which must be signed by you and your parent or guardian. These forms might be given to you by a school counselor, a local Rotarian or can be sent to you by email. You may email RYLA5730@gmail.com for further instructions or information.
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