Hide Section - Personal Information - Please fill out all fileds in this section in order to successfully submit this application.

Personal Information - Please fill out all fileds in this section in order to successfully submit this application.

*Numeric values only. Alphabets, dashes, spaces etc are not allowed.
*Numeric values only. Alphabets, dashes, spaces etc are not allowed.
*Numeric values only. Alphabets, dashes, spaces etc are not allowed.
Hide Section - Emergency Contact - Please fill out all fileds in this section in order to successfully submit this application.

Emergency Contact - Please fill out all fileds in this section in order to successfully submit this application.

*Numeric values only. Alphabets, dashes, spaces etc are not allowed.
*Numeric values only. Alphabets, dashes, spaces etc are not allowed.
*Numeric values only. Alphabets, dashes, spaces etc are not allowed.
Hide Section - Health - Please fill out all fileds in this section in order to successfully submit this application.

Health - Please fill out all fileds in this section in order to successfully submit this application.

Hide Section - Education - Please fill out all fileds in this section in order to successfully submit this application.

Education - Please fill out all fileds in this section in order to successfully submit this application.

Hide Section - Occupation - Please fill out all fileds in this section in order to successfully submit this application.

Occupation - Please fill out all fileds in this section in order to successfully submit this application.

Hide Section - Recreational Intrests & Involvement - Please fill out all fileds in this section in order to successfully submit this application.

Recreational Intrests & Involvement - Please fill out all fileds in this section in order to successfully submit this application.

Hide Section - Other Questions - Please fill out all fileds in this section in order to successfully submit this application.

Other Questions - Please fill out all fileds in this section in order to successfully submit this application.

NOTE: If this form is submitted electronically, the sponsoring Rotary Club must print out this page and have it physically signed by the applicant during their interview I, being the Applicant,

  • Understand that I will be required to abide by the Code of Conduct and adhere to all the requirements and instructions of the director and staff of RYLA during my participation in the programme and that in the event of my failure to do so in a reasonable manner I may be returned to my home by the first available transport, with any additional costs so incurred being paid by myself, parents or guardian.
  • Understand that RYLA is held in a camp environment and that I will be required to share a single sex dormitory with others.
  • In accordance with the Privacy Act, agree to my name and contact details being used on a list of awardees for RYLA follow-up and administration purposes.
  • I authorise the Chairman – RYLA Operational Committee, where it is impractical to communicate with me, or to secure my prior consent, to consent on my behalf to any medical or surgical treatment as may be necessary for my well-being and I undertake to meet such cost incurred.