CAMPER APPLICATIONS  Due by FRIDAY February 23 2018

Camper Information:

First Name
Last Name
Name on your name tag
Camper email Address
Gender MaleFemale
Birth Date
Grade
Name of School you attend
Home Phone Number
Cell Phone Number
Home Address
 
City, State , CA
ZIP code
T-shirt size
Physical Limitations (if none type "none")
List any medications you take and reasons for taking them
Dietary Restrictions

Upload Camper Photo: (REQUIRED)
max size 1024x768px, jpg or jpeg only

(jpg, jpeg, gif, png)

Your Parent or Guardian information:

Parent/Guardian name(s)
Parent/Guardian email
Parent/Guardian Cell Phone Number

Sponsoring Rotary Club

Terms and Conditions


Acceptance I certify that I am over 18 and I am the Legal Parent or Guardian of the student named above and I approve of his or her attendance at this event.
Acceptance I certify that both my student and I have read the What Not to Bring (CLICK TO DOWNLOAD) Portion of the Camp Guidelines and agree that my student will not violate the No Electronic Device Policy.
Acceptance I acknowledge that by my electronic signature below I agree to the General Release of Liability Terms contained in this agreement (CLICK TO DOWNLOAD).
electronically sign this document using your touch pad or mouse

REQUIREMENTS REQUIRING PARENTAL CONSENT:

a) Your parent or guardian MUST APPROVE this application by signing electronically above.
b) Your parent or guardian full contact information must be included above
c) DOWNLOAD these RYLA CAMPER FORMS:

  1. What NOT TO bring (Electronic Device Policy) (PDF)
  2. What to bring with you (PDF)