Parent Application | Camp RYLA | Rotary Districts 5950/5960

Download the YMCA Agreement

This agreement must be downloaded and signed prior to completing form. You will be required to upload it during the application process.

YMCA Agreement PDF

Step 1 of 2

This field is for validation purposes and should be left unchanged.

Parent / Guardian Information

Name(Required)

First Last

Email(Required)

Phone(Required)

May we send texts to this number, if needed?(Required)

Yes

Student Information

Students Name(Required)

First Last

Does your child have any special dietary needs that would be helpful for staff to know or may require accommodation?

Does your child have any religious or other personal matters that would be helpful for staff to know or may require accommodation?

Would you like to discuss any of the above with a member of camp staff prior to the camp including discussions of housing, meals or other matters where you might want/need special accommodations?(Required)

Yes

Upload YMCA Agreement(Required)

Drop files here or

Accepted file types: pdf, jpg, Max. file size: 24 MB.

Gender Inclusiveness: Camp RYLA Operates within the framework of The Rotary Four-Way Test of the things we Think, Say or Do: “1) Is it the TRUTH? 2) is it FAIR to all concerned? 3) Will it build GOODWILL and better FRIENDSHIPS? and 4) Will it be BENEFICIAL to all concerned?” These principles are the foundation of Rotary International’s policies on gender inclusiveness. Rotary’s policy aligns with that of the YMCA Camp St. Croix to provide students the opportunity to express their gender in terms of their understanding of who they are and how they interact with other people. However, we are unable to accommodate mixed gender cabins or bathroom facilities. Students are assigned cabins based upon their physical gender characteristics.

CAMP RYLA MEDIA/PHOTO RELEASE FORM

I hereby grant Camp RYLA, Rotary District 5950, and Rotary District 5960 permission to use my child's likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration.

I understand and agree that all photos will become the property of Camp RYLA, Rotary District 5950, and Rotary District 5960 and will not be returned.

I hereby irrevocably authorize Camp RYLA, Rotary District 5950, and Rotary District 5960 to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo.

I hereby hold harmless, release, and forever discharge Camp RYLA, Rotary District 5950, and Rotary District 5960 from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I HAVE READ AND UNDERSTAND THE ABOVE PHOTO RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE.

TRANSPORTATION/MEDICAL

In the event that my child needs immediate medical attention for injuries received while participating in Camp RYLA, I authorize either YMCA staff and/or RYLA Camp staff to give my child reasonable first aid, and to arrange transport of my child to a health care facility for emergency services as needed.
I give permission for my child to be transported by the YMCA as needed for field trips, inclement weather, or late pick up. I also give my permission for my child to participate in walking filed trips.
I hereby acknowledge that the YMCA and Camp RYLA staff will assume that either parent of the child may pick up the child at any time during the program unless there is pertinent court documentation on file at the YMCA that indicates otherwise.
I agree to the release of any records necessary for treatment, referral, billing for insurance purposes. The YMCA and Camp RYLA staff receive medical information on campers/participants that may need to be shared with medical providers.
If my child requires use and administration of an epi-pen, prescription or over the counter medication, it is my responsibility to ensure that the epi-pen and/or medications are on my child or within their personal belongings every day of the program. If YMCA staff or RYLA Staff are required to administer the use of the epi-pen and/or medication, I agree to forever release and discharge the designees from any and all liability arising out of or resulting from use or administration of the epi-pen and/or medication.

Group Name: Camp RYLA

Dates on Site: April 24-28, 2026

Parent or Guardian Signature(Required)

Use your finger (on touch screen) or mouse to sign in the box above.

Date(Required)

Name(Required)

First Middle Initial Last