RYLA 2022 Registration Packet Final

RYLA 2022 Registration Packet

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Rocky Mountain RYLA
RYLA 2022 Participant Registration Packet

Overview and Instructions

The packet below collects important information that we need to successfully manage the conference and provide the best experience possible for all RYLA participants. Please complete this packet as soon as possible. Participants will not be allowed to attend the conference without a completed packet.

Helpful Hints

· The packet is broken up into several pages. You will not be able to move to the next page of the packet if you do not complete each item on the page that is a required item.

· At the bottom of each page is a button labeled “Save and Continue Later”. Clicking this button will save a copy of your partially completed form on our website and provide a UNIQUE link back to our site. SAVE THIS LINK! You can use this unique link to return to our site and finish the packet later. There is also an option to receive the link via email.

· On the very last page of the packet you can review your entire packet before pressing the “Submit” button. Please print a copy of this page and bring the printed copy it to the conference.

Questions?

If you have any questions please reach out to us via our “Contact Us” form, which you can find by clicking HERE.

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RYLA Entry ID

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ParticipantEmailForNotification

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Participant Information

Here is the information provided by the Participant on their RYLA Application. Please contact your Rotary Club Representative immediately if any of this information is incorrect.

Participant First Name

Participant Last Name

Participant Nick Name

Use Nick Name on your badge instead of First Name?

Yes, use my Nick Name

No, use my First Name

Gender

Participant Birthdate

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Participant Email

Participant Phone

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RYLA Conference

Parent/Guardian Name

Parent/Guardian Email

Parent/Guardian Phone

Emergency Contact Information

Please update if necessary.

Emergency Contact Name

Emergency Contact Phone

Sponsoring/Affiliated Rotary Club

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Participant & Parent Commitment

IMPORTANT COVID VACCINATION INFORMATION: All participants are required to be FULLY VACCINATED and BOOSTERED (If eligible). 12-17 year olds are considered "fully vaccinated" two weeks after receiving a second dose of an mRNA COVID-19 vaccine or two weeks after you get a single dose of the Janssen/Johnson & Johnson COVID-19 vaccine.

You are eligible for booster 5 months after your second Pfizer shot. Currently, the CDC has not authorized boosters for Moderna or Johnson & Johnson for 12-17 year-olds.

If eligible for a booster shot you must receive the booster at least one full week prior to the RYLA conference. One week prior means receiving your booster by Sunday July 12 to be considered up to date.

Instructions

Please check the box near each of the following items. RYLA participants and their parent or legal guardian must also provide their signature in the space provided below.

COVID-19 Vaccination & General Health Policies(Required)

Each RYLA Participant (both youth and adult leaders) eligible under CDC Guidelines to receive a COVID-19 vaccination must be fully vaccinated (including boosters, if eligible) and provide electronic proof of COVID-19 vaccination status in order to attend RYLA.
Additionally, all participants must abide by any other health-related requirements established by Rotary International, Rocky Mountain RYLA, Larimer County, and YMCA of the Rockies, such as the wearing of face masks, being subjected to COVID-19 testing, etc.

I agree to the vaccination/booster and health policy.

Following RYLA Conference Rules(Required)

I (RYLA Participant) agree to follow all RYLA Rules as specified at the rockymountainryla.org website and in this form/web page, and to preferably travel to and from RYLA either with parent(s)/guardian(s) or by transportation arranged by my sponsoring Rotary Club which might involve transportation with a legally licensed and insured designated Rotarian driver.

I/We agree to follow all RYLA conference rules

Media/Photography Release(Required)

I/We agree to, and understand that, as a participant, I may be photographed during RYLA, and that Rotary and its representatives may use RYLA photographs or images in publications or communications primarily to educate and promote awareness of RYLA and Rotary’s commitment to youth.

I/We agree to the Media/Photography release

RYLA Participant Signature(Required)

Participant - please sign your name in the space below.

RYLA Parent/Guardian Signature(Required)

Parent/Guardian - please sign your name in the space below.

Health Information

Please upload proof of COVID-19 vaccination. Photos of CDC vaccination cards or digital copies of vaccination records from state health departments are accepted.

Additional information from the CDC regarding eligibility for Covid-19 booster shots is available here: CDC Booster Information

Nebraska Applicants: You can request a copy of your vaccination record here: Nebraska Dept. Health

Colorado Applicants: You can request your vaccination record on-line here: Colorado Dept. Public Health

Note: PDF format preferred.

Proof of COVID-19 Vaccination Status(Required)

Accepted file types: pdf, jpg, jpeg, gif, png, Max. file size: 512 MB.

Dietary Restrictions

Please list any dietary restrictions

Permission to Provide Necessary Treatment or Emergency Care (Parent/Guardian - Please Sign)(Required)

I hereby give permission to the medical personnel selected by the RYLA Director to order x-rays, routine tests, treatment, to release any records necessary for insurance purposes, and to provide or arrange necessary related transportation for me or my child. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the RYLA Director to secure and administer treatment, including hospitalization, for the person named above.

Insurance Information

Is the participant covered under a medical insurance plan?(Required)

Yes

Insurance Plan Carrier

Group/Policy Number

Name of Insured

Relationship to Participant

Please upload a copy of your insurance card (front and back)

We ask for a copy of your medical insurance card in order to facilitate treatment in case of a medical emergency. PDF format is preferred.

Drop files here or

Accepted file types: jpg, jpeg, pdf, png, gif, Max. file size: 512 MB, Max. files: 3.

Parent/Guardian Authorization and Release

Health and Safety Authorization(Required)

I do voluntarily consent to my son’s or daughter’s good health and to participation in all RYLA activities, to be held at YMCA of the Rockies in Estes Park, Colorado, on the aforementioned date. I assume responsibility for any medical or treatments fees or costs incurred directly or indirectly because of said minor’s participation.

I am aware that all possible precautions are in place to protect my son/daughter from exposure to the COVID-19 virus and that detailed plans exist to deal with such exposure(s) should they occur.

I also authorize the representative(s) of Rotary Districts 5440 and 5450 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, secure professional treatment for and/or to order injections, anesthesia, and/or surgery for the minor named above.

I agree and authorize

Release, Assumption of Risk, and Agreement to Hold Harmless(Required)

In consideration of the sponsoring Rotary Club and Rotary International Districts 5440 and 5450, 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 the Rocky Mountain RYLA Inc., the sponsoring Rotary Club, Rotary International Districts 5440 and 5450, their committees, employees, agents, representatives and volunteers harmless from any and all liabilities, actions, causes of action, claims or demand of any kind and nature whatsoever that may arise by or in connection with my child’s participation in any activities related to RYLA.

The terms here shall serve as a release and the assumption of the risk for my child, his or her heirs, estate, executor, administrator, and assignees as well as members of my family. I grant Rotary Districts 5440 and 5450 and the sponsoring Rotary Club permission to use the image of the above-named minor for educational and promotional purposes. In addition, Rotary Districts 5440 and 5450 may contact the above-named minor regarding other Rotary programs, including, but not limited to, Interact, Rotaract, speech contest, musical performance contest and scholarship opportunities.

I assume risk and agree to hold harmless

Parent/Guardian Printed Name(Required)

Parent/Guardian Signature(Required)

Please sign in the space below.

RYLA Rules, Code of Conduct, and Non-Discrimination Policy

Please check the boxes to acknowledge the following:

Rules and Code of Conduct(Required)

I understand that any violation of the RYLA Rules and Code of Conduct may result in my being expelled from the conference and sent home at the expense of my parent/guardian.

Our program is designed for participants to develop authentic connections free of any preconceived perceptions that may be inferred from articles of clothing, apparel, and other items featuring provocative or controversial content. As such, we kindly request participants to leave these items at home.

No alcohol or illegal drugs (nor vape pens of any kind) or recreational drugs are allowed on the premises.

Use of Tobacco or Nicotine is not permitted at any time on the premises.

Students are not permitted off-site at any time.

The use of cell phones, cameras, video recording devices and other internet connective devices is not allowed during conference meeting and activity time unless approved by RYLA staff.

I agree to follow the Code of Conduct

Non-Discrimination Policy(Required)

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.

I understand the non-discrimination policy

Final Review - Please Print This Page Now

Please review your completed form and make any necessary changes before clicking the "Submit" button. We recommend printing this page as you may need to present a printed copy of this packet at the conference check-in. Do not click "Submit" unless you are sure it is complete. If you need more time to complete this packet, use the "Save and Continue Later" button.

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