RYPEN Camp Nomination Form 2024

Rotary Youth Program of Enrichment 9685 Winter Camp 

14th - 16th June 2024

Become, Discover, Be Challenged

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Email *
Full name of participant: *
This will be the name printed on graduation certificate.
Preferred name or nickname:
This will be the name used on camp name badge.
Date of birth: *
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Gender: *
Mobile number, for participant or carer: *
Is this mobile number you've just given us for participant or carer? *
Participant's Email: *

We only send out acceptance information via email so require a correct email address. You need to monitor that email address for your acceptance information, including checking spam or junk folders. If you do not receive any information by the 25th May 2024, please contact Amanda Barnes on winterrypen@gmail.com

Parent / care giver email:
Home / postal address (incl. postcode): *
Sponsoring Rotary Club (this is the Rotary club that has agreed to financially sponsor participants attendance) : *
Participant's School: *
Current grade at school: *
T-shirt size - adult sizing: *
Talents, Sport, Hobbies and Interest:

There is a talent show as part of the camp and participants are encouraged, but not required to participate with individual talents.

Any matters that may affect camp participation or that mentors should be aware of?

This will be kept completely confidential, but is essential for mentor preparedness – eg physical or mental diversity or impairment, significant recent events, social or behavioural challenges, gender identity.

NB: Medication requirements and details are collected later in this form.

Do you have any dietary requirements? *
If yes, you will be asked to provide details in the next section.
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