Ryla Teen Application

RYLA TEEN APPLICATION

Deadline to submit this application is March 1, 2018.

TEEN INFORMATION (PLEASE PRINT)

PLEASE ANSWER THE FOLLOWING QUESTIONS ON A SEPARATE SHEET OF PAPER.
NOTE: Answers should not exceed 50 words per question. Please type or write (print) clearly.

What are you passionate about?
What are your hobbies and interests?
Tell us about one or two of your goals that you have set for yourself.
How do you make a difference in the lives of your family, friends and community? (For example, do you help take care of younger siblings, help your parents or grandparents or volunteer at a local non-profit)?
What motivated you to apply to attend RYLA?
What type of service projects/service organizations interest you most? Please check your top two choices.
FORMCHECKBOX Elderly/Senior Care Service FORMCHECKBOX Youth Service FORMCHECKBOX Disadvantaged Service
FORMCHECKBOX Outdoor/Nature Service FORMCHECKBOX Other:

PARENT/GUARDIAN INFORMATION
Parent/Guardian Name______

Mailing Address ______
Home Phone ______Work Phone ______Cell Phone ______

I give permission for______to attend RYLA 2018 in Whitehorse, YT, Thur May 3-Sun May 6, 2018.
I understand that I am responsible for arranging necessary time away from school, including travel time.
I/We have reviewed and agree to the RYLA 2018 FAQ’s.
If I have questions, I will contact the local Rotary Club Representative below with any questions.
I give permission for photos to be taken and published for Rotary activities for print or web. __ Yes or __ No

______
Parent/Guardian Signature Date Teen Signature Date

Printed name: Printed name:

Any questions? Please contact:
Wasilla Sunrise Rotary Club Sherie Vieira (907) 982-1391

Rotary Club RYLA REP Name Phone EMAIL or Fax

ROTARY YOUTH LEADERSHIP AWARDS 2018

Name: Gender: M / F
High School: Grade: 10 or 11
Age: Birthday (DD/MM/YYYY): / /
Mailing Address: City:
Province/ State: Postal / ZIP Code:
Home telephone: ( ) Cell Phone: ( )
Email 1: Email 2:
Sweatshirt size (circle one): S M L XL XXL Other:______Tee shirt size (circle one): S M L XL XXL Other:______